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CHIAPAS EDI 2012 USER MANUAL

1. N N N N N N l l l l l l l l l DOOLITTLE CHIAPAS HOSPITAL 123400001 EDI TECH 273801950 1 987654324 STROGANOFF ABIGAIL 00000005 5 0 DOOLITTLE CHIAPAS HOSPITAL 123400001 EDI TECH 273801950 2 987654325 PEAS DELORES 00000006 6 0 DOOLITTLE CHIAPAS HOSPITAL 123400001 EDI TECH 273801950 3 987654326 HASHBROWNS PENELOPE 00000007 7 0 DOOLITTLE CHIAPAS HOSPITAL 123400001 EDI TECH 273801950 4 987654327 PASTA EDWIN 00000008 8 0 DOOLITTLE CHIAPAS HOSPITAL 123400001 EDI TECH 273801950 5 987654332 CHIPOTLE AARON 00000013 13 0 Now that we idea about how Chiapas EDI 2012 works at a high level to translate between EDI messages and database objects we need to review the exact specifics of how CGIF works One of the primary focuses for CGIF is to make a strong division between metadata and business data Metadata which belong to the elements highlighted in orange in the HIPAA sample identifies the data being encoded and is part of the complex encoding standard defined in 5010 Chiapas EDI 2012 uses a special syntax within the column name itself in lieu of metadata to discretely define the data being encoded which defines the loop element and possibly the composite element Following that is a condensed version of the Implementation Name for that element which is the real business purpose of that element Not shown in this example is a special pr
2. EN EI 987654325 PEAS DELORES N 00000006 EI 987654326 HASHBROWNS PENELOPE N 00000007 0 EI 987654327 PASTA EDWIN N 00000008 0 5 2J EI 987654332 l IL 1 CHIPOTLE AARON N 00000013 RMR AZ 13 0 SE 21 100000000 GE 1 1 EA 1 100000000 Zw zu nj c 11 z ay SHE SHE 3 5 e H CHIAPAS EDI 2012 USER MANUAL Page 19 ID NR 0_ L2300B 501 RMRO2 INS REMTNC REF NR OVL HEALTH INS POLCY NR x a z a x lt H 4 gt n a a z a a H u gt gt gt lt l Ez z a a gt o a H o q q a E 2 2 Q H a a gt 1 a gt 2 a a a o o H gt gt gt a a a a a o e z H a x z z z gt H H i i 1 m FE gt sz oO o 1 m gt gt e st o x x lt x a a a a a vul st z e e z z E E 1 d 2 2 z a 12 1 d d d a d d 1 zi Un UN n E i 4 lt x
3. two user defined variables to the events spawned by the strDestfile Visitas trigger In this case the values we entered in Data01 To Data02 will populate to these two defined string variables T CGateState 04 i CGateCNNFlatFromTable Using the predefined C3 CGateCNNFlatFromTable connection TriggerDB this opens up the view passed to i the strSourceView variables and loads into the Flat register CGateSeg CGateHKeyFromFlat This transfers the information from the Flat register to the HKey register 3 CGateXItEncode CGateTransfer 4 CGateSeg This sets commonly used formatting options that will be used on the finalized output file Note that Action SegPool gt File Chiapas requires these options to be set prior to encoding File Path strDestFile System Date This encodes the HKey register to the SegPool register CGateTransfer This is set to the action SegPool gt File which saves the SegPool register to an arbitrary file The filename is described in a Visual Basic expression contained within the File Path box In order to go one step deeper we would have to look at the next step in the chain the vw Export 270 view that we specified originally in the trigger setup If we open SQL Server Management Studio and right click on the vw Export 270 view within the chiapasData distributi
4. 1_27 These views link to the mock data covered in the vw Export 271 vw Export 276 Mock Object Schema section to produce a fully EXpOPt 277 HIPAA compliant for each of the twelve 5010 vw_Export_278_REQ vw_Export_278_RESP vw Export 820 mock business data to the CGIF naming convention Ea accepted by Chiapas EDI 2012 To see how this is vw_Export_837D done right click on the view within SQL Server vw Export 837I vw Export 837P Implementation Guides The views reformat the Management Studio and click Create To to see a new window showing all of the documented SQL source code within these views The Seed Specification Defintions chapter later in this manual covers the output in a way similar to how it would be documented in a Companion Guide CHIAPAS EDI 2012 USER MANUAL Page 89 Encoder Tutorial In this section we ll investigate using the Scheduler linked with the encoder example workflow to encode a database view to a HIPAA file on a periodic basis 1 Launch C chiapas bin ChiapasStudio exe 2 At the top of the screen pull down the Window menu option and select Scheduler Interface 3 Switch to the All Triggers pane 4 Press the New button Press OK 5 Select the new trigger that was generated The screen will look like this E Schedulerinterface File Window Help Active Triggers All Triggers Pending Events TSRC WF FILENAME TSRC_CREATEDAT SCHEDUL
5. REF ID Reference Identification Hierarchical Transaction BHT04 Beginning of STHDR 502 BHTO4 TS CREATN DT Transaction Set Creation Date Hierarchical Transaction BHT 5 Beginning of STHDR 502 BHTO5 TS CREATN Transaction Set Creation Time Hierarchical Transaction SEO1 Transaction Set STHDR 504 SEO1 SEG CT Transaction Segment Count Trailer 5 02 Transaction Set STHDR 504 SEO2 Transaction Set Control Number Trailer Loop INFORMATION SOURCE 2000A LEVEL HL 1 Information Source L2000A SO1 HLO1 HIERCHCL ID NR Hierarchical ID Number Level Loop PAYER NAME 2100A NM103 Payer Name L2100A SO1 NM103 PAYR NM OVL NONP Payer Name Non Person Entity RSN ENTY NM109 Payer Name L2100A 501 109 PAYR ID OVL PAYR Payer Identifier Payor Identification ID Loop INFORMATION RECEIVER 2000B LEVEL HLO1 Information Receiver L2000B 501 HLO1 HIERCHCL ID NR Hierarchical ID Number Level HLe2 Information Receiver L2000B 501 HLO2 HIERCHCL PARNT ID Hierarchical Parent ID Number Level _NR Loop INFORMATION RECEIVER 2100B NAME NM102 Information Receiver L2100B SO1 NM102 ENTY TYPE QUAL Entity Type Qualifier Name NM103 Information Receiver L2100B 501 NM103 NFO RECVR LAST 0 Information Receiver Last or Organization Name Name RG NM NM109 Information Receiver L2100B 501 109 NFO RECVR ID NR Information Receiver Identification Number Name OVL ETN NR Electronic Transmitter Identification Number ETIN Loop SERVICE PROVIDER 2000C LEVEL HLO1 Serv
6. TYPE QUA Entity Type Qualifier L NM103 Requester Name L2010B 1P 501 NM103 REQSTR LAST 0 Requester Last or Organization Name RG NM NM104 Requester Name L2010B 1P 501 104 REQSTR FNAME Requester First Name NM109 Requester Name L2010B 1P 501 109 REQSTR ID OVL Requester Identifier Employer s EMPLYR ID NR Identification Number Loop SUBSCRIBER LEVEL 2000C HLO1 Subscriber Level L2000C 501 HLO1 HIERCHCL ID NR Hierarchical ID Number HLO2 Subscriber Level L2000C 501 HLO2 HIERCHCL ID Hierarchical Parent ID Number _NR CHIAPAS EDI 2012 USER MANUAL Page 112 04 Subscriber Level L2000C 501 HLO4 HIERCHCL CHILD CD Hierarchical Child Code Loop SUBSCRIBER NAME 2010C NM103 Subscriber Name L2010C SO1 NM103 SUB LNAME Subscriber Last Name NM104 Subscriber Name L2010C 501 NM104 SUB FNAME Subscriber First Name NM109 Subscriber Name L2010C 501 109 PRIMRY ID OVL ME Subscriber Primary Identifier Member M ID NR Identification Number DMG 2 Subscriber L2010C 506 DMGO2 BIRTH DT OVL DT Subscriber Birth Date Date Expressed in Demographic CCYYMMDD Format CCYYMMDD Information DMG03 Subscriber L2010C 506 DMGO3 GENDR CD Subscriber Gender Code Demographic Information Loop PATIENT EVENT LEVEL 2000 01 Patient Event Level L2000E SO1 HLO1 HIERCHCL ID NR Hierarchical ID Number HLO2 Patient Event Level L2000E 501 HLO2 HIERCHCL ID Hierarchi
7. Double click in the Workflow File field and in the resulting Open File Dialog select the file C chiapas xaml binDecoder xaml 7 Click on the Polling Info tab 8 Select the Local Archive Poll radio button 9 For the Archive Dir textbox fill in C chiapas input 10 Press the Save button 11 Create a new folder called input off of the C chiapas directory 12 Switch to the Trigger Info tab press Enabled and press Save Press OK 13 Open SQL Server Management Studio and open up a new query window off of the chiapasData database 14 Run the following queries COUNT FROM BIN 834 5 COUNT FROM BIN 837D 5 COUNT FROM BIN 8371 5 Ur Uy C Ed uH COUNT FROM BIN 837P 5 ELECT COUNT FROM BIN LOG CHIAPAS EDI 2012 USER MANUAL Page 93 15 The results should all be 0 assuming this is the first time the example is run if not you can TRUNCATE all of these example tables 16 Copy these four files from C chiapas sample into the C chiapas input directory seed 270 txt 8 10 2012 9 22AM Text Document 3 KB seed 2711 8 31 2012 3 32 PM Text Document 4 KB seed 276 txt 9 1 2012 10 40 AM Text Document 3 KB seed 2771 9 1 2012 12 56 PM Text Document 3 KB seed 278 req txt 9 1 2012 10 21 PM Text Document 1 seed 278 resp txt 9 2 2012 12 0
8. 000029 000030 000031 000032 000033 000034 000035 000036 000037 000038 10220381 15 00 00 ZZ SAMPL GS HC SENDR ID RECVR ID 20120908 2343 1 ST 837 100000000 005010X222A1 BHI 0019 00 984419 20120908 2349 CH NM1 41 2 DOOLITILE HOSPITAL 46 12340 PER IC CHIAPAS EDI TE 4154699607 NM1 40 2 CHIAPAS EDI TECH 46 2738019 HL 1 20 1 NM1 85 2 CHIAPAS EDI TECH N3 126 CARDENAS AVE N4 SAN FRANCISCO CA 941320000 REF EI 273801950 HL 2 1 22 0 SBR P 18 x CI NM1 IL 1 BURGER JOHN MI 000001 N3 123 A ST N4 SAN FRANCISCO CA 94117 DMG D8 19800707 M NM1 PR 2 CHIAPAS EDI TECH PI 2738019 N3 126 CARDENAS AVE N4 SAN FRANCISCO CA 94132 CLM 000001 150 11 B 1 Y A Y Y HI BK 34600 NM1 82 2 DOOLITTLE CLINICS REF G2 C11999 LX 1 SV1 HC 99213 150 UN 1 1 DIP 472 D8 20120101 CLM 000012 375 11 B 1 Y A Y Y HI BK 34600 NM1 82 2 DOOLITTLE CLINICS REF G2 C11999 LX 1 SV1 HC 99212 200 UN 1 1 DIP 472 D8 20120122 LX 2 SV1 HC 99283 175 UN 1 1 DIP 472 D8 20120110 HL 3 1 22 0 m D Chiapas T O Session Datal O Flat HKey Window 81 48 09 Operation complete Specification 5010 837P 1 m 01 48 09 SegPool file Operation complete EDI TECHNOLOGIES Inc
9. Arguments CNNName Name of the connection CNNFileName Full path to a text file containing SQL commands CHIAPAS EDI 2012 USER MANUAL Page 63 CGateCNNSQLGetScalar This activity will execute a SQL query against a connection and then store the result into the specified variable The variable should be of type object If the query returns a null result the object variable will be set to System DBNull Value Arguments CNNName Name of the connection CNNSQL text of the SQL query to execute Result An L Value object type variable that will store the result of the query The name of the variable should not be quoted CGateCNNFlatToTable This activity will export the contents of the Flat register to a table on the specified connection All data types will be set to VARCHAR 200 fields Arguments CNNName Name of the connection CNNTable Name of the table the Flat register will be stored to CNNReplace if this string value is set to true the table will be dropped if it exists and recreated CGateCNNFlatFromTable This activity imports the Flat register from a specified SQL table on the indicated connection The SQL table should consist of VARCHAR 200 fields without a primary key and all fields should be named according to Chiapas Gate Intermediate Format naming convention CHIAPAS EDI 2012 USER MANUAL Page 64 Arguments CNNName Name of the connection CNNTable Name of the table the Flat re
10. The Schedule Info tab allows a great deal in flexibility in when and how often a Scheduled trigger is fired Note that whenever the schedule is updated Chiapas EDI will reset the last polled date to the current date time Here is a breakdown of the various options Run Once Only The trigger will execute immediately when it is enabled but not thereafter This is useful for testing the trigger Second Interval This specifies that the Interval window specifies the number of seconds between trigger fires Note that the Polling Interval specified on the Trigger Info tab takes precedence over this value A value of 0 in both the Polling Interval and here could possibly freeze the machine and make it unresponsive Minute Interval Here the Interval specifies how many minutes between trigger fires Hourly Interval This specifies the number of hours between trigger fires Start Time End Time These should be values like 8 00 PM or 23 00 30 When populated the triggers will be limited to firing during this time span Be cautious when scheduling triggers between 1 AM and 2 AM as shifts in Daylight Savings Time could lead to missed triggers or unintentionally running a trigger twice in one night Date Span Clicking on the checkbox will enable to Calendar controls that allow you to specify a date range when the trigger can fire Day of Week This checkbox will enable the Weekday checkboxes that allow you to limit the tri
11. gt lt 504 gt lt 505 gt DTP03 STATS NFO EFF DT OVL ELIG D8 220120101 DTP03 STATS EFF DT OVL ELIG BEGN D8 S05 L2100A gt lt 501 gt NM103 MEM OVL gt lt 103 MEM _ OVL 5 gt NM104 MEM FNAME 2GEORGIA lt 104 MEM gt lt 501 gt lt 502 gt lt 04 COMM NR OVL HOM NR 24155551213 PERO4 COMM NR OVL HOM PHON NR lt 502 gt lt 503 gt lt 301 ADRS LIN 111 U ST N301 ADRS LIN lt 503 gt lt 504 gt lt 401 CITY gt 5 5 lt 401 CITY NM lt 402 STAT gt lt 402 STAT CD lt 403 MEM POSTL ZON ZIP 0 gt 94117 lt 403 POSTL ZON ZIP CD lt 504 gt lt 505 gt DMG02 BIRTH DT OVL DT CCYYMMDD219500505 DMG02 BIRTH DT OVL DT gt DMG03 GENDR CD F c DMG03 GENDR CD lt 505 gt L2100A IL lt L2000 gt Note that this is not a complete file but this snippet serves as a guide to how the names of CGIF elements are split into XML element names XML To HKey This option causes Chiapas EDI to load the XML file into the HKey register The XML elements must follow a specific naming convention as described in the example above with loops segments and elements as three different hierarchical levels HKey to XML Exports the HKey register to an XML file XML File XML file to be loaded or saved SegPool Reg
12. 11999 1 E 000010 N3 126 CARDENAS AVE 72008 DOOLTTTLE CLINICS 11498 x 000011 N4 SAN FRANCISCO CA 941320000 Jase serre z w 000012 REF EI 273801950 DOOLITTLE CLIMICS C11999 1 E 1 ial seer Im RR 0000151 AMIA TL 1 BURGER JOHN MI 000001 war DOXITTLE CLINICS ciisss x 99 L no0ic N3 123 A ST E 000017 N4 SAN FRANCISCO CA 94117 000018 DMG D8 19800707 M Eu zz E 000019 NMi PR 2 CHIAPAS EDI TECH PI 2738019 000020 N3 126 CARDENAS AVE CEN 000021 N4 SAN FRANCISCO CA 94132 veer DOOLTTTLE 5 cuisses x sel 000022 CIM 000001 150 11 8 1 Y A Y Y 000023 HI BK 34600 000024 NM1 82 2 DOOLITILE CLINICS 000025 REF G2 C11999 000026 LX 1 000027 SV1 HC 99213 150 UN 1 1 000028 DTP 472 D8 20120101 1000029 CLM 000012 375 11 B 1 Y A Y Y 000030 HI BK 34600 000031 NM1 82 2 DOOLITILE CLINICS 000032 REF G2 C11999 0083xeeoe19 000033 LX 1 Hat Encode 000034 SV1 HC 99212 200 UN 1 1 HKey 013 _ 000035 DTP 472 D8 20120122 000036 1 2 Error Count 90000 000037 SV1 HC 99283 175 UN 1 1 000038 DTP 472 D8 20120110 SegPool 980235 3 10000391 HL 3 1 22 0 T 2 HIG Page 268 Lm CHIAPAS EDI 2012 USER MANUAL Page 10 The middle pane represents the
13. 80COL Scrub PHI Flat eeeexeoooo0 Encode t rc RR chiapas sample Hs 455 gt gt SegPool File C chiapas sample seed_834 txt Decode Error Count 0000 GEGEN NE ENDE SeoS EleS SegPool NUS HIG Page SubEleSep CHIAPAS EDI 2012 USER MANUAL Page 9 On the SegPool pane you will notice that the SegPool File box is already filled out with a default value Double click the mouse cursor within the white area of the SegPool File area and select a new file C NchiapasNsampleNseed 837p txt Now leaving the default File to SegPool radio button selected press the Execute button On the right side of the screen the SegPool Msgs window is filled in with the contents of the file This is some of the mock healthcare data that is included with the distribution Next press the Decode button in the lower left part of the screen The middle area of the screen is divided into two tabbed areas Flat and HKey Click on the HKey tab now and then press the Flat HKey button Now click on the Flat tab again The screen at this point will look similar to this SegPool Msgs SegPool Msgs 000001 000002 000003 000004 000005 000006 000007 000008 000009 000010 000011 000012 000013 000014 000015 000016 000017 000018 000019 000020 000021 000022 000023 000024 000025 000026 000027 000028
14. Date Service Date L2400 S04 DTPO3 SVC DT OVL SVC D8 Service Date Service D8 Specification 5010 837P Loop ISA GROUP HEADERS ISA 2 Interchange X1_OEISA_S 1_ISA 2_AUTH_NFO_OVL_NO_A Authorization Information No Authorization Control Header UTH_NFO Information Present 5 04 Interchange OEISA 501 15404 SEC OVL NO SEC Security Information No Security Information Control Header FO Present 5 06 Interchange OEISA 501 5 06 SENDR ID OVL MUTLY D Interchange Sender ID Mutually Defined Control Header EFND ID 5 08 OEISA 501 ISAO8 RECVR ID OVL MUTLY D Interchange Receiver ID Mutually Defined Control Header EFND ID ISA09 Interchange OEISA 501 15409 DT Interchange Date Control Header ISA10 Interchange OEISA 501 ISA10 Interchange Time Control Header ISA11 Interchange OEISA 501 ISA11 REPTN SEPRTR Repetition Separator Control Header ISA12 Interchange OEISA 501 ISA12 VERSN NR Interchang Control Version Number Control Header ISA13 Interchange OEISA 501 ISA13 Interchange Control Number Control Header ISA14 Interchange 501 5 14 Acknowledgment Requested Control Header ISA15 Interchange OEISA 501 ISA15 USG IND Interchange Usage Indicator Control Header ISA16 Interchange OEISA 501 ISA16 SUBELE SEP Component Element Separator Control Header IEAO1 Interchan
15. STHDR HEADER STO2 Transaction Set STHDR 501 STO2 CONTRL NR Transaction Set Control Number Header 01 Beginning of STHDR 502 BHTO1 STRUCTR CD Hierarchical Structure Code Hierarchical Transaction BHT 2 Beginning of STHDR_S 2_BHT 2_TS_PURPS_CD Transaction Set Purpose Code Hierarchical Transaction BHT03 Beginning of STHDR 502 BHTO3 ORGNTR APLCTN TRANSC Originator Application Transaction Identifier Hierarchical TN ID Transaction BHT04 Beginning of STHDR 502 04 TS CREATN DT Transaction Set Creation Date Hierarchical Transaction BHT 5 Beginning of STHDR 502 BHTO5 TS CREATN Transaction Set Creation Time Hierarchical Transaction BHT 6 Beginning of STHDR 502 BHTO6 ENCNTR ID Claim or Encounter Identifier Hierarchical Transaction SEQ1 Transaction Set STHDR S06 SEO1 SEG CT Transaction Segment Count Trailer 5 02 Transaction Set STHDR 506 5 02 Transaction Set Control Number Trailer Loop SUBMITTER NAME 1000A CHIAPAS EDI 2012 USER MANUAL L1000A 501 NM103 SUBMTR LAST ORG OVL NONPRSN ENTY L1000A 501 NM109 SUBMTR ID OVL L1000A 502 PERO2 CONTCT NM Address Page 120 Submitter Last or Organization Name Non Person Entity Submitter Identifier Electronic Transmitter Identification Number ETIN Submitter Contact Name L1000A 502 PERO4 COMM NR OVL TELPHN 11000 501 NM103 RECVR NM OVL NONPRS N ENTY 11000 501 NM109 PRIMRY ID OVL ETN L2000A 501
16. connectionstrings com Flat to Table Exports loaded Flat register data to a database table Table to Flat Loads Flat register from a database table Note that the table must only contain CGIF compatible field names DB Type Pull down to select the database connection type Data Source A valid SQL Connection String Table For exports this will contain the name of the database table to export records to if it doesn t exist a table will be created as described above For data imports this can be the name of a table a view or the SQL of a SELECT statement Execute Button When all parameters are filled in this will actually run the export or import Any errors will be reported in the Message Log area Merge Button This feature is available only for SQL Server or SQLite connection strings and enables a special Export functionality where the loaded DataKey register will be merged into an existing database table Only the CGIF fields common to both the source and destination will be inserted to the backend table CGIF fields present on the source DataKey and not present within the destination table will be flagged as errors in the Error Log CHIAPAS EDI 2012 USER MANUAL CSV Flat HKey SegPool Log DB Table CSV Excel Flat to CSV Execute CSV to Flat CSV File Excel Flat HKey SegPool Log DB Table CSV Excel Flat to Excel Execute Flat to Lock Excel File HKey Register
17. element Mismatch with Data Type datatype Missing qualifier for an identifier This element is not a valid value for this element Data not present on an element marked as Required X12Decoder LoopParse Premature End of File Detected Mandatory Segment Loop Segent Not Found Mandatory Loop Loop Not Found Segment Loop segment Exceeded Maximum Iterations max iter Loop Loop Exceeded Maximum Iterations repeats X12Decoder DecodeX12File Insufficient segments found within source X12 file Insufficient elements in the Group Envelope GS segment This is not a HIPAA 4010 5010 file ChiapasGate could not determine the specification from the information within the file Premature End of File Unknown specification encountered Decode Failure Exception during parsing X12Heir VerifySegment ERROR H005 E either but not both Requirement Condition violated condition at segment name ERROR H006 R at least one needs to be present Requirement Condition violated condition at segment name ERROR H007 L if first present 2nd or 3rd is required Requirement Condition violated condition at segment name ERROR H008 P if one is present both are needed Requirement Condition violated condition at segment name ERROR H009 C if first is present second is required Requirement Condition violated condition at
18. CT NM1 IL 1 BURGER JOHN MI O000001 N3 123 A ST N4 SAN FRANCISCO CA 94117 DMG D8 19800707 M NM1 PR 2 CHIAPAS EDI TECH PI 2738019 N3 126 CARDENAS AVE N4 SAN FRANCISCO CA 94132 CLM 000001 150 11 B 1 Y A Y Y HI BK 34600 NM1 82 2 DOOLITTLE CLINICS REF G2 C11999 LX 1 SV1 HC 99213 150 UN 1 1 DTP 472 D8 20120101 CHIAPAS EDI 2012 USER MANUAL Page 14 To save the results to a new EDI file go to the Data I O pane on the left Select the SegPool to File radio button click on the CR and LF checkboxes and enter a filename under the SegPool File textbox Then press Execute and a new file will be generated Flat HKey SegPool Log File 999 Ack 9 SegPool to File File to SegPool Execute CR V LF 1 80501 Scrub PHI SegPool File C chiapas new_output txt SegSep SubEleSep EleSep This concludes the Encode example CHIAPAS EDI 2012 USER MANUAL Page 15 USER REFERENCE INTRODUCTION This section will cover the essential functions of Chiapas EDI 2012 beginning from Chiapas Studio and proceeding through the core functions of scheduling and automation It will cover the Chiapas Gate Intermediate Format which is used by Chiapas EDI to convert between hierarchical element references and fixed column names The main objective of this section is to give the user an understanding of the fundamentals of EDI translation and how Chiapas EDI can be used to integrate HIPAA tr
19. Mapping Loop ISA GROUP HEADERS ISAe2 Interchange Control 00 OEISA 501 ISAO02 AUTH NFO OVL Authorization Information No Authorization Header O AUTH NFO Information Present 5 04 Interchange Control OEISA 501 15404 SEC NFO OVL NO SE Security Information No Security Information Header C NFO Present 5 06 Interchange Control OEISA 501 5 06 SENDR ID OVL Interchange Sender ID Mutually Defined Header DEFND ID 5 08 Interchange Control OEISA 501 ISAO8 RECVR ID OVL Interchange Receiver ID Mutually Defined Header Y DEFND ID ISA09 Interchange Control OEISA 501 9 DT Interchange Date Header ISA10 Interchange Control OEISA 501 ISA10 Interchange Time Header ISA11 Interchange Control OEISA 501 ISA11 REPTN SEPRTR Repetition Separator Header ISA12 Interchange Control OEISA 501 ISA12 VERSN NR Interchang Control Version Number Header ISA13 Interchange Control OEISA 501 ISA13 Interchange Control Number Header ISA14 Interchange Control 501 5 14 REQ Acknowledgment Requested Header ISA15 Interchange Control OEISA 501 ISA15 USG IND Interchange Usage Indicator Header ISA16 Interchange Control OEISA 501 ISA16 SUBELE SEP Component Element Separator Header IEAO1 Interchange Control OEISA 503 IEAe1 GS Number of Included Functional Groups Trailer IEAO2 Interchange Control OE
20. Message MsgData Str MsgData Numi MsgData Num2 IsError TimeStamp EVENT ID MSGLOG NR Data Type INT PK VARCHAR 200 VARCHAR 200 VARCHAR 200 VARCHAR 200 VARCHAR 200 VARCHAR 200 VARCHAR 200 VARCHAR 200 VARCHAR 200 Purpose Primary Key Identity Chiapas EDI Module that created the message Error Message Message Data String Message Data Num 1 Message Data Num 2 Flags whether this message is an error Timestamp of when the error was generated ID of the triggering Event Number indicating the sequence of the message within the event CHIAPAS EDI 2012 USER MANUAL TSRC Table Page 79 This table is responsible for storing active and inactive triggers The different types of triggers are covered in the chapter on the Scheduling System Column Name TSRC ID TSRC ENABLED TSRC TYPE TSRC WF FILENAME TSRC POLL INTERVAL TSRC NAME TSRC DATAO1 TSRC DATAO2 TSRC DATAO3 TSRC_DATA04 TSRC DATAO5 TSRC CREATEDAT Data Type INT PK INT VARCHAR 50 VARCHAR 250 INT VARCHAR 50 VARCHAR 4000 VARCHAR 4000 VARCHAR 4000 VARCHAR 4000 VARCHAR 4000 DATETIME Purpose Primary Key Identity 0 Trigger Disabled 1 Trigger Enabled Indicates the type of trigger Valid values are SCHEDULED EVENT SQL TRIGGERED EVENT LOCAL UPLOAD DIRECTORY EVENT LOCAL ARCHIVE DIRECTORY EVENT REMOTE UPLOAD DIRECTORY EVENT REMOTE A
21. PRI DIAG CD VARCHAR 10 SEC DIAG CD VARCHAR 10 STATUS VARCHAR 10 ADJUDCTN DT DATE Purpose Unique Claim Identifier Foreign Key to Provider table Foreign Key to Member table Patient Account Number Facility Type Code Primary Diagnosis Code Secondary Diagnosis Code Claim Adjudication Status Claim Adjudication Date CHIAPAS EDI 2012 USER MANUAL Page 82 Claim Detail Table This table represents the Claim Detail data linked to the mock claims within the mock database The Claim Details are linked many to one to the Claim Header table Column Name Data Purpose CLAIM DTL ID PK Unique Claim Detail Line Identifier CLAIM ID INT Foreign Key reference to the Claim Header table AMT MONEY Claim Line Charge Amount COPAY AMT MONEY Claim Line Patient Copay Amount PAID AMT MONEY Claim Line Paid Amount FROM DT DATE Claim Line Service From Date TO DT DATE Claim Line Service To Date SVC CD VARCHAR 10 Claim Line Procedure Code UNIT CT INT Claim Line Unit Count CHIAPAS EDI 2012 USER MANUAL Page 83 Claim Adjustment Table This table represents adjustments made on Claim Line details Column Name CLAIM ADJ ID CLAIM DTL ID ADJ_REASN ADJ_AMT ADJ_SEQ Data Type INT PK INT VARCHAR 2 MONEY INT Purpose Unique Claim Detail Adjustment Identifier Foreign Key reference to the Claim Detail table Adjustment Reason Code Adjustment Amount Adjustment Sequence CH
22. The values returned are 4010 270 BIN 4010 270 A1 BIN 4010 271 BIN 4010 271 A1 BIN 4010 276 BIN 4010 276 A1 BIN 4010 277 BIN 4010 277 A1 BIN 4010 278 REQ BIN 4010 278 REQ A1 BIN 4010 278 RESP BIN 4010 278 RESP A1 BIN 4010 820 BIN 4010 820 A1 BIN 4010 834 BIN 4010 834 A1 BIN 4010 835 BIN 4010 835 A1 BIN 4010 837D BIN 4010 837D A1 BIN 4010 8371 BIN 4010 8371 A1 BIN 4010 837P BIN 4010 837P A1 BIN 5010 270 BIN 5010 270 A1 BIN 5010 271 BIN 5010 271 A1 BIN 5010 276 BIN 5010 277 BIN 5010 277CA BIN 5010 278 REQ BIN 5010 278 RESP BIN 5010 820 BIN 5010 820 A1 BIN 5010 834 BIN 5010 834 A1 BIN Health Care Eligibility Benefit Inquiry 270 Addenda 1 Health Care Eligibility Benefit Inquiry Response 271 Addenda 1 Health Care Claim Status Request 276 Addenda 1 Health Care Claim Status Response 277 Addenda 1 Health Care Services Review Request for Review 278 Addenda 1 Health Care Services Review Response 278 Addenda 1 Payroll Deducted and Other Group Premium Payment for Insurance Product 820 Addenda 1 Benefit Enrollment and Maintenance 834 Addenda 1 Health Care Claim Payment Advice 835 Addenda 1 Health Care Claim Dental 837 Addenda 1 Health Care Claim Institutional 837 Addenda 1 Health Care Claim Professional 837 Addenda 1 Health Care Eligibility Benefit Inquiry 270 Addenda 1 Health Car
23. VARCHAR 50 VARCHAR 2 VARCHAR 20 VARCHAR 50 VARCHAR 50 VARCHAR 50 Purpose Unique Provider Identifier Federal Tax ID National Provider Identifier Company Name First Name Last Name Address Line 1 Address Line 2 City State ZIP Code Contact Name Work Phone Email CHIAPAS EDI 2012 USER MANUAL Page 87 Tutorials Chiapas EDI 2012 includes a number of pre built workflows including a full fledged automated decoding system In this section we will tie the Scheduling system together with the workflow system to see full demonstrations of the encoder and decoder automation systems at work First let s cover the inventory of the sample files and database objects included with the Chiapas EDI 2012 distribution File System File Purpose The sample directory contains seed 5010 files for every specification They are the result of the output of the included 5010 database views after they are fed into the Chiapas EDI 2012 encoder Each of these files has undergone extensive testing to meet the full Implementation Guide syntax and business requirements therefore they can be used as the seed of new transaction extracts C chiapas sample seed_270 txt Health Care Eligibility Benefit Inquiry C chiapas sample seed_271 txt Health Care Eligibility Benefit Response C chiapas sample seed_276 txt Health Care Claim Status Request chiapas sample seed_277 txt Health Care Claim St
24. with the sub tabs below them representing discrete interfaces for each specific register ME s tee At the bottom of the Data I O Interface area is a small Error Count 09000 information pane showing the current state of the HIG Page 232 various Chiapas EDI 2012 registers The Encode button will encode a loaded HKey register to the SegPool register The Decode button will decode a loaded SegPool register to the HKey register Flat Register Tab This pane presents interfaces for loading Flat data and exporting to one of the supported destinations DB Table This pane enables the user to import data from or export data to a SQL database Interfaces for ODBC Ole SQL Server and SQLite are Flat HKey SegPool Log DB Table CSV Excel Flat To Table u 4 Enoto presented If the database type is SQLite Table to Flat Merge 1 s Or SQL Server it will detect if a table exists and DB Type SQL Server M if not automatically create it when exporting Data Source Source Database chiapasData Trusted Connection data with all fields having the VARCHAR 200 true TE vw Export data type The Data Source field must be populated with a valid connection string with the table CHIAPAS EDI 2012 USER MANUAL Page 27 representing a table or view for importing or a table name for export For a good resource containing examples of valid SQL Server connection strings visit http
25. 94 Let s go to the Workflow interface and open up the binDecoder xaml 21 CGateContext CJ CGateArg strFileName CGateState 01 To CGateState Arg02 CGateState Arg03 CGateState 4 AB Assign strFileName C chiapas input CGateTransfer Action SegPool lt File File Path strFileName 3 CGateXItDecode 2 CGateHKeyToFlat 11 CGateQueryState CGateCNNSQLGetScalar 1 CGateMerge J CGateCNNSQLExec CGateArg This activity is the glue between the automation syste and workflow Here the Local Archive Directory Poll will pass a single argument containing the filename without path that triggered this event Note If in the future you need the full path and filename of the triggering stimuli for a Local Archive Directory Poll you could access the event data directly using a CGateCNNSQLGetScalar activity Create string variable within the CGateContext scope called TRIG EVENT ID Then set the variable via the CGateQueryState with an argument of EVENT ID Then set create a new CGateCNNSQLGetScalar activity with the TriggerDB connection and the following query SELECT TSRC DATAO1 V EVENT DATAO1 FROM EVENTS INNER JOIN TSRC ON EVENTS TSRC ID TSRC TSRC ID WHERE EVENT ID TRIG EVENT ID This will allow you to assign the full path and filename to an Activity scoped variable Assign This assignment restores the path information to the trigge
26. BEGN D8 CHIAPAS EDI 2012 USER MANUAL Page 102 SUBSCRIBER ELIGIBILITY OR BENEFIT INFORMATION Loop 2110C EBO1 Subscriber Eligibility or Benefit Information L2110C 501 EBO1 BENFT NFO Eligibility or Benefit Information Subscriber Eligibility or Benefit Information L2110C 501 EBO3 SVC TYPE CD Service Type Code Specification 5010 276 Loop ISA GROUP HEADERS ISAe2 Interchange Control 00 OEISA 501 ISAO02 AUTH NFO OVL Authorization Information No Authorization Header O AUTH NFO Information Present 5 04 Interchange Control OEISA 501 15404 SEC NFO OVL NO SE Security Information No Security Information Header C NFO Present 5 06 Interchange Control OEISA 501 5 06 SENDR ID OVL MUTL Interchange Sender ID Mutually Defined Header DEFND ID 5 08 Interchange Control OEISA 501 ISAO8 RECVR ID OVL Interchange Receiver ID Mutually Defined Header Y DEFND ID ISA 9 Interchange Control OEISA_S 1_ISA 9_DT Interchange Date Header ISA10 Interchange Control OEISA 501 ISA10 Interchange Time Header ISA11 Interchange Control OEISA 501 ISA11 REPTN SEPRTR Repetition Separator Header ISA12 Interchange Control OEISA 501 ISA12 VERSN NR Interchang Control Version Number Header ISA13 Interchange Control OEISA 501 ISA13 Interchange Control Number Header ISA14 Interchange
27. BIN WHEN TYPE IN 5010 8371 5010 8371 1 5010 8371 2 THEN INSERT INTO BIN 837I 5 SELECT FROM BIN WHEN TYPE 5010 837P 5010 837P 1 THEN INSERT INTO BIN 837P 5 SELECT FROM BIN END EXECUTE SQL SET SQL DROP TABLE BIN EXEC SQL CHIAPAS EDI 2012 USER MANUAL Page 97 END This code will create a new BIN LOG entry and use that as a key to aggregate the new rows within the other BIN tables Then it drops the temp table to clean up CHIAPAS EDI 2012 USER MANUAL Page 98 Seed Specification Definitions The following specifications define the output generated by the vw Export views when fed into the Chiapas EDI encoder as well as describing the resulting seed files located within the c chiapas sample directory Specification 5010 270 Reference Segment CGR Mapping Loop ISA GROUP HEADERS ISAe2 Interchange Control 1 OEISA 501 ISAO2 AUTH NFO OVL N Authorization Information No Authorization Header O AUTH NFO Information Present 5 04 Interchange Control OEISA 501 5 04 SEC NFO OVL PASSW Security Information Password Header D 5 06 Interchange Control OEISA 501 5 06 SENDR ID OVL Interchange Sender ID Mutually Defined Header DEFND ID 5 08 Interchange Control OEISA 501 ISAO8 RECVR ID OVL Interchange Receiver ID Mutually Defined Header Y DEFND ID ISA09 Inte
28. BPR 2 Financial STHDR 502 BPRO2 TOTL ACTL PROV PMT Total Actual Provider Payment Amount Information MT OVL REMTNC NFO ONLY Remittance Information Only BPRO3 Financial STHDR 502 BPRO3 CREDT DEBT FLAG CD Credit or Debit Flag Code Information 4 Financial STHDR 502 BPRO4 PMT METHD CD Payment Method Code Information BPR16 Financial STHDR 502 BPR16 IS EFT EFF DT Check Issue or EFT Effective Date Information TRNe2 Reassociation STHDR 503 TRNO2 EFT TRAC NR Check or EFT Trace Number Trace Number TRN 3 Reassociation STHDR 503 TRNO3 PAYR ID Payer Identifier Trace Number REF02 Receiver STHDR 505 REFO2 RECVR ID OVL RECVR I Receiver Identifier Receiver Identification Identification D NR Number DTMe2 Production Date STHDR 507 DTMO2 PRODCTN DT OVL PRODC Production Date Production TN SEO1 Transaction Set STHDR S12 SEO1 SEG CT Transaction Segment Count Trailer 5 02 Transaction Set STHDR S12 5 02 Transaction Set Control Number Trailer Loop PAYER 1000A IDENTIFICATION N102 Payer L1000A SO1 N102 PAYR NM Payer Name Identification N104 Payer L1000A 501 N104 PAYR ID OVL MDCR MDC Payer Identifier Centers for Medicare and Identification D SVCS PLAND Medicaid Services PlanID N301 Payer Address L1000A 502 301 ADRS LIN Payer Address Line 01 Payer City L1000A 503 401 CITY NM Payer City Name State ZIP Code N402 Payer City L1000A 503 402 STAT CD Payer State Code State ZIP Code 03 Payer City L1000A 503 03 PAYR POS
29. Control OEISA 501 ISA14 REQ Acknowledgment Requested Header ISA15 Interchange Control OEISA 501 ISA15 USG IND Interchange Usage Indicator Header ISA16 Interchange Control OEISA 501 ISA16 SUBELE SEP Component Element Separator Header IEAO1 Interchange Control OEISA 503 IEAO1 GS Number of Included Functional Groups Trailer IEAO2 Interchange Control OEISA 503 2 ICN Interchange Control Number Trailer Loop GROUP HEADER GSHDR 6502 Functional Group GSHDR 501 GSO2 APP SENDR CD Application Senders Code Header GS03 Functional Group GSHDR 501 6503 APP RECVR CD Application Receivers Code Header 6504 Functional Group GSHDR 501 6504 DT Date Header GS05 Functional Group GSHDR 501 GSO5 Time Header GS06 Functional Group GSHDR 501 6506 Group Control Number Header GEO1 Functional Group GSHDR 503 GEO1 TS CT Number of Transaction Sets Included Trailer GE 2 Functional Group GSHDR_S 3_GE 2_GCN Group Control Number Trailer Loop TRANSACTION SET STHDR HEADER 5 02 Transaction Set STHDR 501 STO2 CONTRL NR Transaction Set Control Number Header ST 3 Transaction Set STHDR 501 STO3 VERS RELS INDSTRY Version Release or Industry Identifier Header ID CHIAPAS EDI 2012 USER MANUAL Page 103 01 Beginning of STHDR 502 BHTO1 STRUCTR CD Hierarchical Structure Code Hierarchical Transaction BHT 3 Beginning of STHDR 502
30. Hierarchical Child Code Payer Responsibility Sequence Number Code Individual Relationship Code Claim Filing Indicator Code Subscriber Last Name Person Subscriber First Name Subscriber Primary Identifier Member Identification Number Subscriber Address Line Subscriber City Name Subscriber State Code Subscriber Postal Zone or ZIP Code Subscriber Birth Date Date Expressed in Format CCYYMMDD Subscriber Gender Code Payer Name Non Person Entity Payer Identifier Payor Identification Payer Address Line Payer City Name Payer State or Province Code Payer Postal Zone or ZIP Code 12300 501 CLMO1 PATNT CONTRL NR 12300 501 CLMO2 TOTL CHG AMT 12300 SO1 CLMO5 01 PLAC SVC CD L2300 501 CLMO5 FREQNCY CD OV L PLAC SVC CODS PROF DENTL 12300 501 06 PROV SUPLR SIGNTR IN D 12300 501 CLMO7 ASGNMNT PLAN PARTCPT N CD 12300 501 8 BENFTS ASGNMNT CERT IND 12300 501 CLMO9 RELS NFO CD 12300 543 HIO1 02 DIAG CD OVL ICD9CM PRINCPL DIAG 12300 543 02 02 DIAG CD OVL ICD9CM _DIAG Patient Control Number Total Claim Charge Amount Place of Service Code Claim Frequency Code Place of Service Codes for Professional or Dental Provider or Supplier Signature Indicator Assignment or Plan Participation Code Benefits Assignment Certification Indicator Release of Information Code Diagnosis Code International Classification of Diseases Clinical Modification ICD 9 CM Pri
31. Number Trailer Loop TRANSACTION SET STHDR HEADER CHIAPAS EDI 2012 USER MANUAL Page 99 STO2 Transaction Set STHDR 501 STO2 CONTRL NR Transaction Set Control Number Header BHTO1 Beginning of STHDR S02 BHTO1 STRUCTR CD Hierarchical Structure Code Hierarchical Transaction BHT 2 Beginning of STHDR 502 BHTO2 TS PURPS CD Transaction Set Purpose Code Hierarchical Transaction BHT03 Beginning of STHDR 502 BHTO3 SUBMTR TRANSCTN I Submitter Transaction Identifier Hierarchical D Transaction BHT04 Beginning of STHDR 502 04 TS DT Transaction Set Creation Date Hierarchical Transaction BHT 5 Beginning of STHDR 502 BHTO5 TS CREATN Transaction Set Creation Time Hierarchical Transaction SEO1 Transaction Set STHDR 504 SEO1 SEG Transaction Segment Count Trailer 5 02 Transaction Set STHDR S04 5 2 Transaction Set Control Number Trailer Loop INFORMATION SOURCE 2000A LEVEL HLO1 Information Source L2000A 501 HLO1 HIERCHCL ID NR Hierarchical ID Number Level Loop INFORMATION SOURCE 2100A NAME NM103 Information Source L2100A PR 501 NM103 NFO SOURC LAS Information Source Last or Organization Name Name T ORG NM OVL NONPRSN ENTY Non Person Entity NM109 Information Source L2100A PR 501 NM109 NFO SOURC PRI Information Source Primary Identifier Name MRY ID OVL FED TAX ID NR Federal Taxpayer s Identificat
32. PROV FNAME L2310A 503 2 ATNDNG PROV 2ND ID OVL PROV COMRCL NR L2400 SO1 LXO1 ASGND NR L2400 S02 SV201 SVC LIN REVN CD L2400 502 SV202 02 PROC CD OVL HCPCS _ L2400 S02 SV203 LIN ITM CHG AMT L2400 502 SV205 UNT CT OVL UNT Page 124 Subscriber Gender Code Payer Name Non Person Entity Payer Identifier Payor Identification Payer Address Line Payer City Name Payer State Code Payer Postal Zone or ZIP Code Patient Control Number Total Claim Charge Amount Facility Type Code Claim Frequency Code Uniform Billing Claim Form Bill Type Assignment or Plan Participation Code Benefits Assignment Certification Indicator Release of Information Code Statement From and To Date Statement RD8 Admission Type Code Admission Source Code Patient Status Code Principal Diagnosis Code International Classification of Diseases Clinical Modification ICD 9 CM Principal Diagnosis Other Diagnosis International Classification of Diseases Clinical Modification ICD 9 CM Diagnosis Attending Provider Last Name Person Attending Provider First Name Attending Provider Secondary Identifier Provider Commercial Number Assigned Number Service Line Revenue Code Procedure Code Health Care Financing Administration Common Procedural Coding System HCPCS Codes Line Item Charge Amount Service Unit Count Unit CHIAPAS EDI 2012 USER MANUAL Page 125
33. S11 DTPO3 PROPSD ACTL ADMS Proposed or Actual Admission Date Admission N DT OVL ADMSN D8 D8 Specification 5010 278 RESP Loop ISA GROUP HEADERS ISA 2 Interchange Control OEISA 501 ISAO2 AUTH NFO OVL Authorization Information No Authorization Header O AUTH NFO Information Present 5 04 Interchange Control OEISA 501 15404 SEC NFO OVL NO SE Security Information No Security Information Header C NFO Present 5 06 Interchange Control OEISA 501 5 06 SENDR ID OVL Interchange Sender ID Mutually Defined Header Y DEFND ID 08 Interchange Control OEISA 501 ISAO8 RECVR ID OVL Interchange Receiver ID Mutually Defined Header Y DEFND ID ISA09 Interchange Control OEISA 501 9 DT Interchange Date Header ISA10 Interchange Control OEISA 501 ISA10 Interchange Time Header ISA11 Interchange Control OEISA 501 ISA11 REPTN SEPRTR Repetition Separator Header ISA12 Interchange Control OEISA 501 ISA12 VERSN NR Interchang Control Version Number Header ISA13 Interchange Control OEISA 501 ISA13 Interchange Control Number Header ISA14 Interchange Control OEISA 501 ISA14 REQ Acknowledgment Requested Header ISA15 Interchange Control OEISA 501 ISA15 USG IND Interchange Usage Indicator Header ISA16 Interchange Control OEISA 501 ISA16 SUBELE SEP Component Element Separator Header IEAO1 Inter
34. SO1 N104 PAYR ID OVL FED TAX I Premium Payer Identifier Federal Taxpayer s Name D NR Identification Number Loop INDIVIDUAL 2000B REMITTANCE ENTO1 Individual 12000 501 ENTO1 ASGND NR Assigned Number Remittance 04 Individual L2000B 501 ENTO4 RECVR INDVDL ID OVL Receiver s Individual Identifier Employee Remittance EMPLY ID NR Identification Number Loop INDIVIDUAL NAME 2100B NM103 Individual Name L2100B IL 501 NM103 INDVDL LNAME Individual Last Name NM104 Individual Name L2100B IL 501 NM104 INDVDL FNAME Individual First Name NM109 Individual Name L2100B IL 501 NM109 INDVDL ID OVL INS Individual Identifier Insured s Unique RD UNQ ID NR Identification Number Loop INDIVIDUAL 2300B PREMIUM REMITTANCE DETAIL RMRO 2 Individual L2300B 501 RMRO2 INS REMTNC REF NR OV Insurance Remittance Reference Number Health Premium L HEALTH INS POLCY NR Insurance Policy Number Remittance Detail RMRO4 Individual L2300B 501 RMRO4 DETL PMT AMT Detail Premium Payment Amount Premium Remittance Detail Specification 5010 834 Reference segment Mapping Loop ISA GROUP HEADERS ISAe2 Interchange T1 OEISA 501 15402 AUTH NFO OVL NO A Authorization Information No Authorization Control Header UTH NFO Information Present 5 04 OEISA_S 1_ISA 4_SEC_NFO_OVL_PASSWD Security Information Password Control Header 5 06 Interchange OEISA 501 5 06 S
35. Tab New Delete Save CHIAPAS EDI 2012 USER MANUAL Page 51 Chiapas EDI 2012 supports the following trigger types LOCAL UPLOAD DIRECTORY EVENT The background service will poll a specified directory for files If any are found the file is moved to an archive location and the trigger is fired LOCAL ARCHIVE DIRECTORY EVENT The background service will poll a specified directory for new files If a new file is found it is recorded in an internal table and a trigger is fired REMOTE UPLOAD DIRECTORY EVENT Here the background service will use a pre defined WinSCP session complete with fixed username and password and scan a specified directory for new files similar as above REMOTE ARCHIVE DIRECTORY EVENT The background service uses a pre defined WinSCP session and scans a directory for new files similar to the local version SCHEDULED EVENT The background service will wait until a specified time or date using a number of different criteria SQL TRIGGERED EVENT If a given connection string and query return a 1 result this fires the trigger Active Triggers Tab This tab shows the triggers that are currently active and being polled by the background CGateService All Triggers Tab This tab shows all triggers active or not Pending Events This shows the events that are currently being processed by the background service CHIAPAS EDI 2012 USER MANUAL Page 52 Schedule Info Tab New Delete Save Enabled
36. Tab Page 28 This pane Exports a loaded DataKey to a headered CSV file or loads it in from the same The CSV File area can be double clicked to bring up an Open File Dialog Once a valid filename is selected the Execute button will carry out the operation Similar to the CSV Data I O functionality this tab will export a loaded DataKey to a new Excel spreadsheet The extension chosen for the destination filename determines whether it is an Excel 97 or an Excel 2003 format determined by either an xls extension 97 or an xIsx 2003 extension The HKey tab enables transport of the HKey register The HKey register encodes hierarchical data that follows the HIPAA Implementation Guide specifications and presents two transports for importing and exporting this data These transports give developers alternatives to using the Flat register interface for working with HIPAA files CHIAPAS EDI 2012 USER MANUAL Page 29 DB Tables Flat HKey Log This tab presents a transport between SQL La Server database tables and the HKey register When exporting a loaded HKey via the Hkey 9 DB Tables To HKey Execute 3 i to DB Tables radio button Chiapas EDI 2012 HKey to DB Tables Export View will create a number of tables with the DB Type M specified prefix one for each loop present TIS within the transaction Prefix To see how this works in practice let s see an example To replicat
37. Time Hierarchical Transaction BHT06 Beginning of STHDR 502 06 TRANSCTN TYPE CD Transaction Type Code Hierarchical Transaction SEO1 Transaction Set STHDR 504 SEO1 SEG Transaction Segment Count Trailer 5 02 Transaction Set STHDR 504 SEO2 Transaction Set Control Number Trailer Loop UTILIZATION 2000A MANAGEMENT ORGANIZATION UMO LEVEL HLO1 Utilization L2000A 501 HLO1 HIERCHCL ID NR Hierarchical ID Number Management Organization UMO Level HLO4 Utilization L2000A 501 04 HIERCHCL CHILD CD Hierarchical Child Code Management Organization UMO Level Loop UTILIZATION 2010A MANAGEMENT ORGANIZATION UMO NAME NM102 Utilization L2010A X3 501 NM102 ENTY TYPE QUA Entity Type Qualifier Management L Organization UMO Name NM103 Utilization L2010A X3 501 NM103 UMO NM LAST O Utilization Management Organization UMO Management RG NM Name Last or Organization Name Organization UMO Name NM109 Utilization L2010A X3 501 NM109 ID CD OVL EMP Utilization Management Organization UMO Management LYR ID NR Identification Code Employer s Organization UMO Identification Number Name Loop REQUESTER LEVEL 2000B HL 1 Requester Level L2000B SO1 HLO1 HIERCHCL ID NR Hierarchical ID Number 02 Requester Level L2000B 501 HLO2 HIERCHCL PARNT ID Hierarchical Parent ID Number _NR 04 Requester Level L2000B 501 HLO4 HIERCHCL CHILD CD Hierarchical Child Code Loop REQUESTER NAME 2010B NM102 Requester Name L2010B 1P 501 NM102
38. YYMMDD Page 123 Receiver Name Non Person Entity Receiver Primary Identifier Electronic Transmitter Identification Number ETIN Hierarchical ID Number Billing Provider Organizational Name Non Person Entity Billing Provider Address Line Billing Provider City Name Billing Provider State or Province Code Billing Provider Postal Zone or ZIP Code Billing Provider Tax Identification Number Employer s Identification Number Hierarchical ID Number Hierarchical Parent ID Number Hierarchical Child Code Payer Responsibility Sequence Number Code Individual Relationship Code Claim Filing Indicator Code Subscriber Last Name Person Subscriber First Name Subscriber Primary Identifier Member Identification Number Subscriber Address Line Subscriber City Name Subscriber State Code Subscriber Postal Zone or ZIP Code Subscriber Birth Date Date Expressed in Format CCYYMMDD CHIAPAS EDI 2012 USER MANUAL DMG03 Loop 2010BB NM103 NM109 N301 01 902 03 Loop 2300 CLMO1 CLM 2 CLM05 01 CLM05 03 CLM07 CLM 8 CLMe9 DTPe3 CL101 CL102 CL103 CL101 02 CL101 02 Loop 2310A NM103 NM104 REFO2 Loop 2400 LXeo1 SV201 SV202 02 5 203 SV205 Subscriber Demographic Information PAYER NAME Payer Name Payer Name Payer Address Payer City State ZIP Code Payer City State ZIP Code Payer City State ZIP Code CLAIM INFORMATIO
39. filename to upload RemoteFileName The name of the upload when it is uploaded to the remote server CHIAPAS EDI 2012 USER MANUAL Page 70 CGateXFERGetFile This activity requires an open WinSCP session and will get a single named file to the local filesystem Arguments FileName Local path and filename to store the received file RemoteFileName path and filename of the file to get CGateXFERGetDirectoryFiles This activity will store the list of files in a given directory of the current WinSCP session to a supplied string array variable Arguments RemoteDirectory The remote directory containing the files FileList A supplied variable of type string that will store the resulting file list CGateSendMail This activity will open a connection to an SMTP EMail server and send out a message with the given sender receiver subject body and server login credentials Arguments MessageSubject Subject line of the message MessageBody Message body SenderEMail EMail address of the sender ReceiverEMail EMail address of the receiver CHIAPAS EDI 2012 USER MANUAL Page 71 SMTPServer Server name of the SMTP host SMTPUsername Login username on the SMTP host SMTPPassword Login password on the SMTP host SMTP 551 true to connect to the SMTP host with SSL false otherwise If an error occurs during any stage of the process of sending an outgoing Email it will be logged File I O Activities CGate
40. segment name HKEY FromFlat Exception while transferring Flat to HKey CHIAPAS EDI 2012 USER MANUAL Page 74 HKEY_ToFlat Exception while transferring HKey to Flat HKEY FromXmlDoc Exception while transferring XmlDocument to HKey TREE Set The Map Tag was an invalid tree reference CGate SetFromObject Cannot set object Flat is invalid Cannot set object HKey is invalid Cannot set object SegPool is invalid There was difficulty parsing the correct specification XLT Decode X12 Segments are not loaded decode failure Tree not loaded decode failure Exception during Decode operation XLT Encode Hierarchical Key is not loaded with data encode fail CHIAPAS EDI 2012 USER MANUAL Page 75 Technical Reference This chapter will cover the important things developers need in order to be productive with Chiapas EDI 2012 Automation This includes the Data Dictionary of all the objects used by the automation system technical specifics on the scheduling system and finally information about the pre built decode encode automation workflows built into Chiapas EDI 2012 Core Object Schema TSRC EVENTS MSGLOG 7 TSRC ID i EVENT ID t MSGLOG ID TSRC ID EVENT ID FST R FILES FILE IO TSRC ID These represent the core objects needed to run the automation system within Chiapas EDI 2012 Chiapas EDI 2012 uses the file C chiapas bin cnnstr tx
41. testing and debugging them The left pane is the toolbox and contains all of the activities supported within Chiapas EDI 2012 workflows 22 CGateContext The middle pane is the workspace where workflows are constructed The CGateContext is a sequence which in WWF parlance means that it is itself a container for other activities All Chiapas EDI 2012 activities must be reside within a single CGateContext container and these containers cannot be nested It is possible however to ignore the default setup and place a CGateContext within a Sequence along with activities under Control Flow Flowchart Runtime Primitives and Error Handling toolbox headers as these are part of the Windows Workflow environment and do not need to be contained within a CGateContext container 66600600600Qi The right pane displays variables that are associated with any selected activity For Chiapas activities that do not present individual designers interfaces you must enter in values in this pane to interact with the activity Workflow Tutorial CHIAPAS EDI 2012 USER MANUAL Page 46 To really explore how to use the Workflow Studio let s construct a simple workflow step by step from scratch In this example we will load in one of the sample file HIPAA files decode it and export the results to a CSV file in the C chiapas directory Open the Workflow Studio When you first launch Chiapas Studio select Window from the t
42. then Flatten the data and push the results to the Flat register For a demonstration on how Chiapas EDI does this refer to the documentation that covers Export View button within the Data I O Interace Flat HKey This button loads the HKey from the Flat register essentially a reverse of the process described above CHIAPAS EDI 2012 USER MANUAL Page 38 Flat Tab ret tor This interface enables the user to view the Flat register interactively as well as modify both the mappings and the information contained within This capability allows the user to test different situations with data and mappings quickly Note that generally the Flat is loaded either from the Data I O interface or from the HKey pane and then this interface is updated with a snapshot of the data Changing the data and mappings does not directly affect the Flat register the gt Flat and Set buttons are used to actually update the internal register Te OEISA Se OFISA Sel SE OEI STEVE RE EEE TEEVEETER PEED E TE sve sear Set This button propagates the mapping indicated in the Mapping Interface to the currently selected column within the Flat interface Row This will clone the current row and insert a duplicate Row This will remove the currently selected row Col This
43. 0 837D 5010 837D 1 5010 837D 2 THEN SELECT TOP 0 INTO rndtb FROM BIN 837D 5 WHEN TYPE IN 5010 8371 5010 837 1 5010 8371 2 THEN SELECT TOP 0 INTO rndtb FROM BIN 837I 5 WHEN TYPE 5010 837P 5010 837P 1 THEN SELECT TOP 0 INTO rndtb FROM BIN 837P 5 SET SQL SQL ALTER TABLE rndtb DROP COLUMN BIN PK ALTER TABLE rndtb ALTER COLUMN BIN ID INT NULL EXECUTE SQL SELECT rndtb END This stored procedure will use the specification name to drive which of the existing BIN tables it copies and alters to a new temp table This newly created table will be the target of the Chiapas EDI Merge activity which will copy all mappings that the source and destination have in common and log all mappings existing within the source but not the destination as a logged message As all error log messages are recorded automatically at the end of every workflow execution by the automation system no extra activities are needed for this to work CGateMerge This activity will merge in the data from the loaded Flat register to the specified database table and log all fields that don t exist in the destination In this way Chiapas EDI can cope with files having slightly different sets of mappings and still have the bulk of the data stored successfully to a database CHIAPAS EDI
44. 01 43 37 Decode complete healthcare enterprise solutians S10 Health Care Claim Professional De EUER Loop 2310B RENDERING PROVIDER NAME gt te Segment O3 REF Rendering Provider Secondary Identificatio 12007 M Element 02 Rendering Provider Secondary Identifier m Sub Element Overload G2 Provider Commercial Number M CGIF Reference L23108 503 REFO2 RENDRNG PROV 2ND ID OVL PROV COMRCL NR Flat HKey SegPool Log Flat HKey SegPool Msgs SegPool Msgs Set Row gt Fiat HIG l 000001 ISA 00 00 Z2 SAMPI 1230 S4 HIOl L2300 S43 HIO2 123198 Sel NMi03 123108 S03 L2400 Sel L 10000021 GS HC SENDR ID RECVR 1D 2012090842343 1 SegPool to File Execute DOOLITTLE CLINICS 11999 E 000003 ST 837 100000000 005010X222A1 s US Ezy DOOLITTLE CLINICS 11999 1 E 000004 BHT 0019 00 984419 20120908 2349 CH File to SegPool CR 75508 DOOLITTLE CLINICS 21999 1 E 000005 NM1 41 2 DOOLITILE HOSPITAL 46 12340 DOOLITTLE CLINICS 11999 1 39 000006 PER IC CHIAPAS EDI TE 4154699607 80COL E Scrub PHI E DOOLETTLE 5 11999 1 9 000007 NM1 40 2 CHIAPAS EDI TECH 46 2738019 sages DOOLITTLE CLINICS 11999 2 E 000008 HL 1 20 1 SegPoolFile VhispasisampleVseed 837p trt DOXITTLE CLINICS ci1sss 1 9 000009 NM1 85 2 CHIAPAS EDI TECH E DOOLITTLE CLINICS
45. 2012 USER MANUAL Page 96 CGateCNNSQLExec This stored procedure call will transfer the contents of the temp table to one of the main BIN tables as well as log the results to the BIN LOG table It is executed using this syntax USP MOVE TO BIN strTemp1 ToString strType strFileName Looking at the SQL source code to the USP MOVE TO BIN procedure we see this Move the newly imported file into a storage bin CREATE PROCEDURE dbo USP MOVE TO BIN BIN VARCHAR 100 TYPE VARCHAR 20 FILENAME VARCHAR 200 AS BEGIN DECLARE SQL VARCHAR 2000 BIN ID INT SET TYPE REPLACE GTYPE BIN First insert a new BIN LOG record BEGIN TRAN INSERT INTO BIN_LOG BIN FILENAME BIN RECV DATE BIN TYPE SELECT FILENAME GETDATE TYPE SET BIN SCOPE IDENTITY COMMIT TRAN SET SQL UPDATE BIN SET BIN CONVERT VARCHAR BIN ID EXECUTE SQL SET SQL CASE WHEN TYPE IN 5010 834 5010 834 1 THEN INSERT INTO BIN 834 5 SELECT FROM BIN WHEN TYPE IN 5010 837D 5010 837D 1 5010 837D 2 THEN INSERT INTO BIN 837D 5 SELECT FROM
46. 30 000021 CAS OA 42 238 36 000022 REF 6R 4 000023 SVC HC 2L2820 0 150 92 2 000024 DTM 150 20040830 000025 DTM 151 20040830 000026 CAS OA 42 150 92 000027 REF 6R 5 000028 SVC HC2L2275 0 144 74 2 000029 DTM 150 20040830 000030 DTM 151 20040830 000031 CAS OA 42 144 74 000032 REF 6R 6 000033 SE 31 102015216 000034 GE 1 102015215 000035 IEA 1 102015215 mode is to display both simultaneously as shown here However the SegPool and Messages can be shown independently by switching to other tabs CHIAPAS EDI 2012 USER MANUAL Page 40 Menu Options This section describes the menu bar options at the top of the window Session Load Session Save Session This feature lets you save the settings within the Data I O panel to a file that can later be restored There is also a default winstate file within the Chiapas bin directory that represents the default state of these settings it can be overwritten so that every time Chiapas Studio is launched these settings are loaded at the beginning of the session Copy CGIF to Clipboard Copies the currently selected CGIF mapping to the clipboard Open HIG If there is a currently selected mapping and the options have been set properly to link to a set of HIPAA Implementation Guide PDFs available from Washington Publishing Company http wpc edi com this will open the PDF to the page number describing the mapped element Quit This qu
47. 300 S24 NOTO2 TEXT OVL DME SUPLS 12300 S24 0 02 102 TEXT OVL DME SUPLS 12300 S24 0 02 103 TEXT OVL DME SUPLS The 102 and 103 represent the second and third iterations respectively whereas the OVL represents Overload If these mappings were used to encode a HIPAA transaction and NULL values were stored in these columns meaning information present then segments would be generated Scenario 3 TPA Broker Named Loops The HIPAA Implementation Guides will often overload entire loops redefining a single loop to have a number of different meanings CGIF independently addresses each CHIAPAS EDI 2012 USER MANUAL Page 21 named iteration by combining the loop name with the metadata element present within the header segment of that loop One such example is the TPA Broker Name Loop 1000C within the 4010 834 Eligibility specification It contains a definition for both Broker or Sales Office element 1 containing BO or Third Party Administrator element 1 containing TV To define both the name and the required Broker Identification Code the following four mappings are used L1000C BO SO1 N102 BROKR NM L1000C BO 501 N104 TPA BROKR ID OVL FEDRL TAXPYR ID NR L1000C TV 501 N102 BROKR NM L1000C TV 501 N104 TPA BROKR ID OVL FEDRL TAXPYR ID NR Scenario 4 Other Subscriber Information Iterated Loops In HIPAA transactions new database rows are triggered by the deepest key loop This is the deepest loop in the tr
48. 403 POSTL ZON ZIP CD L2010AA 504 REFO2 ID NR OVL EMPLYR I D NR L2000B 501 HLO1 HIERCHCL ID NR L2000B 501 HLO2 HIERCHCL PARNT ID NR Page 126 Originator Application Transaction Identifier Transaction Set Creation Date Transaction Set Creation Time Claim or Encounter Identifier Transaction Segment Count Transaction Set Control Number Submitter Last or Organization Name Non Person Entity Submitter Identifier Electronic Transmitter Identification Number ETIN Submitter Contact Name Communication Number Telephone Receiver Name Non Person Entity Receiver Primary Identifier Electronic Transmitter Identification Number ETIN Hierarchical ID Number Billing Provider Last or Organizational Name Non Person Entity Billing Provider Address Line Billing Provider City Name Billing Provider State or Province Code Billing Provider Postal Zone or ZIP Code Billing Provider Tax Identification Number Employer s Identification Number Hierarchical ID Number Hierarchical Parent ID Number CHIAPAS EDI 2012 USER MANUAL 04 SBRO1 SBRO2 5 09 Loop 2010BA NM103 NM104 NM109 N301 01 N402 DMGO2 DMG 3 Loop 2010BB NM103 NM109 N301 N401 N42 N403 Loop 2300 CLMO1 CLMO2 1 05 01 CLM 5 03 CLMe 6 CLMO7 CLMO8 CLMe9 01 02 CLMO2 02 Loop 2310B Subscriber Hierarchical Level Subscriber In
49. 501 lt ISA12_VERSN_NR gt lt ISA13_ICN gt 100000000 lt ISA13_ICN gt lt ISA14_ACK_REQ gt 0 lt ISA14_ACK_REQ gt lt ISA15_USG_IND gt P lt ISA15_USG_IND gt lt ISA16_SUBELE_SEP gt lt ISA16_SUBELE_SEP gt lt 501 gt lt S03 gt lt IEA02_ICN gt 100000000 lt IEA02_ICN gt lt 503 gt GSHDR lt 501 gt lt GS06_GCN gt 1 lt GS06_GCN gt lt 501 gt lt 503 gt lt GE02_GCN gt 1 lt GE02_GCN gt lt 503 gt Now press the Encode button on the lower left On the right the SegPool register will be loaded and appear like SO GS02 APP SENDR CD 2SENDR ID GS02 APP SENDR CD GS03 APP RECVR CD2RECVR ID GS03 APP RECVR CD GS08 VERS ID CD 2005010X222A1 GS08 VERS ID gt SegPool Msgs 000001 000002 000003 000004 000005 000006 000007 000008 000009 000010 000011 000012 000013 000014 000015 000016 000017 000018 000019 000020 000021 000022 000023 000024 000025 000026 000027 000028 SegPool Msgs ISA 00 00 ZZ SAMPL GS HC SENDR ID RECVR ID 20130706 1113 1 ST 837 100000000 005010X222A1 BHT 0019 00 633279 20130706 1109 CH NM1 41 2 DOOLITTLE HOSPITAL 46 12340 PER IC CHIAPAS EDI TE 4154699607 NM1 40 2 CHIAPAS EDI TECH 46 2738019 HL 19920 1 NM1 85 2 CHIAPAS EDI TECH N3 126 CARDENAS AVE N4 SAN FRANCISCO CA 941320000 REF EI 273801950 HL 2 1 22 0 SBR P 18
50. 78 Users v ec 278 REQ RESF XDSL pd 1 er oer pisnge eaa 20100905 ET 1082 20 EI T Ten Users Aider Destto op APR ge EQ Ic Users A denm Desitog Projects i Chiapas Studio can link directly to the HIPAA Implementatio Guides to pull up a page associated with any mapped element These guides are copyrighted controlled materials and not included with the Chiapas EDI 2012 distribution they must be purchased directly from Washington Publishing Corporation wpc edi org This feature works only with the initially published 4010 and 5010 PDFs that were not corrected with the Addenda Type in the path to the file with each associated specification In the picture at left each PDF was renamed with a prefix indicating HIPAA version and specification the original filenames for each specification is the four characters immediately to the left of the PDF extension GUI Options 1 Refresh Segment Pane on Encode This checkbox controls whether the Segment Pane is displayed after an Encode operation If you are working with extremely large files this can prevent long freezes within the user interface 2 Refresh HKey Pane on Decode Whenever a HIPAA file is decoded the XML within the HKey pane is automatically refreshed If you are working with HIPAA files more than 5 MB in size this can lead CHIAPAS EDI 2012 USER MANUAL Page 43 to user interface freezes Deactivating the interface h
51. 8 PM Text Document 1KB seed 820 txt 9 6 2012 10 14 AM Text Document 1 seed 834 txt 8 10 2012 9 18 AM Text Document 6 KB seed 835 txt 9 7 2012 11 23 PM Text Document 4 KB seed 837d txt 10 9 2012 1 56PM Text Document 4 KB seed 837i txt 8 17 2013 10 26 A Text Document 7 KB seed 837p txt 9 8 2012 11 49 PM Text Document 6 KB 17 Wait 30 seconds 18 Re run the the queries Now the output from SSMS should look like this SQLQuery42 sql I Administrator 79 X JSELECT COUNT SELECT COUNT SELECT COUNT SELECT COUNT SELECT COUNT 100 4 H Results 1 Messages No column na i2 FROM BIN 834 5 FROM BIN 837D 5 FROM BIN 837I 5 FROM BIN 837P 5 FROM BIN 104 At the next poll the automation system discovered four new files in the archive directory and passed these files to the binDecoder workflow This workflow then worked in conjunction with two stored procedures located on the distribution database to route the data into one of four different tables Note that because this workflow is using the Merge functionality arbitrary 837 and 834 files can be used with this process mappings that cannot be stored in the existing tables will be logged as error messages to the MSGLOG table automatically These missing fields can then be added to the destination tables where subsequent decodes will detect these new fields and store information to them CHIAPAS EDI 2012 USER MANUAL Page
52. A 501 08 RECVR ID MUTLY DE Interchange Receiver ID Mutually Defined Control Header FND ID ISA09 Interchange OEISA 501 15409 DT Interchange Date Control Header ISA10 Interchange OEISA 501 ISA10 Interchange Time Control Header ISA11 Interchange OEISA 501 ISA11 REPTN SEPRTR Repetition Separator Control Header ISA12 Interchange OEISA SO1 ISA12 VERSN NR Interchang Control Version Number Control Header ISA13 Interchange OEISA 501 ISA13 ICN Interchange Control Number Control Header ISA14 Interchange OEISA_S 1_ISA14_ACK_REQ Acknowledgment Requested Control Header ISA15 Interchange 5 501 15 15 056 Interchange Usage Indicator Control Header ISA16 Interchange OEISA 501 ISA16 SUBELE SEP Component Element Separator Control Header IEAO1 Interchange OEISA 503 IEAO1 GS Number of Included Functional Groups Control Trailer IEAO2 Interchange OEISA 503 IEAO2 ICN Interchange Control Number Control Trailer Loop GROUP HEADER GSHDR 6502 Functional Group GSHDR 501 6502 APP SENDR CD Application Senders Code Header GS03 Functional Group GSHDR 501 GS03 APP RECVR CD Application Receivers Code Header 6504 Functional Group GSHDR 501 6504 DT Date Header GS05 Functional Group GSHDR 501 6505 6506 Functional Group GSHDR 501 6506 Group Control Number Header GEO1 Functional Group GSHDR S03 GEO1 TS CT Number of Transaction Sets Included Trailer GEO2 Functional Group GSHDR S03 GEO2 Group Control
53. Association Number DENTL ASCTN CD Codes SV302 Dental Service L2400_S 2_SV3 2_LIN_ITM_CHG_AMT Line Item Charge Amount Specification 5010 8371 Reference Segment CGTF mapping Loop ISA GROUP HEADERS ISAe2 Interchange W2 OEISA 501 15 02 AUTH NFO OVL NO A Authorization Information No Authorization Control Header UTH NFO Information Present 5 04 Interchange OEISA 501 15404 SEC NFO OVL NO SEC Security Information No Security Information Control Header FO Present 5 06 Interchange OEISA 501 5 06 SENDR ID OVL MUTLY D Interchange Sender ID Mutually Defined Control Header EFND ID 5 08 OEISA 501 ISAO8 RECVR ID OVL MUTLY D Interchange Receiver ID Mutually Defined Control Header EFND ID ISA09 Interchange OEISA 501 ISAO9 DT Interchange Date Control Header ISA10 Interchange OEISA 501 ISA10 Interchange Time Control Header ISA11 Interchange OEISA 501 ISA11 REPTN SEPRTR Repetition Separator Control Header ISA12 Interchange OEISA 501 ISA12 VERSN NR Interchang Control Version Number Control Header ISA13 Interchange OEISA 501 ISA13 ICN Interchange Control Number Control Header CHIAPAS EDI 2012 USER MANUAL Page 122 ISA14 Interchange OEISA 501 ISA14 REQ Acknowledgment Requested Control Header ISA15 Interchange OEISA 501 ISA15 USG IND Interchange Usage In
54. CHIAPAS EDI 2012 USER MANUAL O Copyright 2014 Chiapas EDI Technologies Inc All rights reserved This work may not be copied or distributed without written prior m EDI TECHNOLOGIES INC authorization CHIAPAS EDI 2012 USER MANUAL Page 2 TABLE OF CONTENTS Contents INTRODUCTION etant 4 INSTALE GUIDE 6 QUICK START GUIDE RENDEREN 8 USER 15 CHIAPAS GATE INTERMEDIATE FORMAT 17 CHIAPAS REGISTERS Et 23 CHIAPAS STUDIO OVERVIEW 25 Workflow Interfaces mtt UIDI III 44 m 49 Workflow Activity d tege edd viene bii qundd 54 REC EG E as M 54 D ta O ACHIV 61 External VO E E 69 File VO AE UVIE BS 71 Message Referenten uneso anann ee er TEn E one ee ee eer eee ee 73 Technical Referen Ecenin iiia 75 Core Object 75 sample Object Schenia e amate A PU m ARUM RS A UR 80 DeL e 87 Encoder Tutorial NN ooo o NP 89 Decade Tu
55. CO 4 CQ On the previous page we saw member and provider information and above we can see a mock claims table that will be encoded to a file There is a single SQL View vw Export 837P that will be used to transform this data into a form that Chiapas EDI can convert to EDI format See the User Reference and Technical Reference for more information about how this works Within Chiapas Studio click on the Flat tab on the left Data I O pane and then select the Table to Flat radio button and type in vw Export 837p within the Table textbox Flat To Table Table to Flat DB Type SQL Server M Data Data Source Source Database chiapasData Trusted Connection true Table vw Export 837p Now press the Execute button Press the Flat tab in the middle Register pane and you will see the data loaded from the View successfully CHIAPAS EDI 2012 USER MANUAL Page 13 Now select the HKey tab in the middle Register pane then press the Flat HKey button The results will appear like this Flat HKey CGIFXMLRoot X12 lt OEISA gt lt 501 gt lt 15 02 AUTH NFO OVL AUTH NFO ISA02 AUT ISA04 SEC OVL NO SEC gt ISA04 SEC NF ISA06 SENDR ID OVL MUTLY DEFND ID SAMPL SENDRID ISA08 RECVR ID OVL MUTLY DEFND ID SAMPL RECVRID ISA11 REPTN SEPRTR ISA11 REPTN SEPRTR lt ISA12_VERSN_NR gt 00
56. Code Billing Provider City State ZIP Code Billing Provider City State ZIP Code Billing Provider Tax Identification SUBSCRIBER HIERARCHICAL LEVEL Subscriber Hierarchical Level Subscriber Hierarchical Level Subscriber Hierarchical Level Subscriber Information Subscriber Information Subscriber Information SUBSCRIBER NAME Subscriber Name Subscriber Name Subscriber Name Subscriber Address Subscriber City State ZIP Code Subscriber City State ZIP Code Subscriber City State ZIP Code Subscriber Demographic Information 11000 501 NM103 RECVR NM OVL NONPRS N ENTY 11000 501 NM109 PRIMRY ID OVL ETN R L2000A 501 HLO1 HIERCHCL ID NR L2010AA 501 NM103 BILNG PROV ORGL NM OVL NONPRSN ENTY L2010AA 502 301 BILNG PROV ADRS LIN L2010AA 503 401 BILNG PROV CITY NM L2010AA 503 N402 STAT PROVNC CD L2010AA 503 N403 POSTL ZON ZIP CD L2010AA 504 REFO2 ID NR OVL EMPLYR I D NR L2000B 501 HLO1 HIERCHCL ID NR L2000B SO1 HLO2 HIERCHCL PARNT ID NR L2000B 501 HLO4 HIERCHCL CHILD CD L2000B 502 SBRO1 PAYR RESP SEQNC NR L2000B 502 SBRO2 INDVDL REL CD L2000B 502 SBRO9 FILNG IND CD L2010BA 501 NM103 SUB LNAME OVL PERS N L2010BA 501 NM104 SUB FNAME L2010BA 501 NM109 PRIMRY ID OVL MEM ID NR L2010BA 502 N301 ADRS LIN L2010BA 503 401 CITY NM L2010BA 503 N402 STAT CD L2010BA 503 N403 SUB POSTL ZON ZIP C D L2010BA 504 DMGO2 BIRTH DT OVL DT CC
57. Control OEISA 501 ISA15 USG IND Interchange Usage Indicator Header ISA16 Interchange Control OEISA 501 ISA16 SUBELE SEP Component Element Separator Header IEAO1 Interchange Control OEISA 503 IEAO1 GS CT Number of Included Functional Groups Trailer IEAO2 Interchange Control OEISA 503 2 ICN Interchange Control Number Trailer Loop GROUP HEADER GSHDR 6502 Functional Group GSHDR 501 GSO2 APP SENDR CD Application Senders Code Header GS03 Functional Group GSHDR 501 6503 APP RECVR CD Application Receivers Code Header 6504 Functional Group GSHDR_S 1_GS 4_DT Date Header GS05 Functional Group GSHDR 501 GSO5 Time Header GS06 Functional Group GSHDR 501 6506 Group Control Number Header 6508 Functional Group GSHDR 501 GSO8 VERS ID CD Version Release Industry Identifier Code Header GEO1 Functional Group GSHDR S03 GEO1 TS Number of Transaction Sets Included Trailer GE 2 Functional Group GSHDR_S 3_GE 2_GCN Group Control Number Trailer Loop TRANSACTION SET STHDR HEADER STO2 Transaction Set STHDR 501 STO2 CONTRL NR Transaction Set Control Number Header 01 Beginning of STHDR 502 BHTO1 STRUCTR CD Hierarchical Structure Code Hierarchical Transaction BHT 2 Beginning of STHDR 502 BHTO2 TS PURPS CD Transaction Set Purpose Code Hierarchical Transaction CHIAPAS EDI 2012 USER MANUAL Page 101 BHT03 Beginning o
58. DI focuses on making the business data within a transaction accessible with as little focus on the HIPAA syntax container as possible To decode a HIPAA file into a form that can be queried and analyzed an analyst need only complete a few simple operations within the included Chiapas Studio Because Chiapas EDI uniquely assigns name to every business element within a HIPAA transaction it can translate EDI directly to a database table without mapping activities traditionally associated with EDI parsers The analyst can choose to either create a new database table reflecting the incoming EDI file or merge data from many EDI files into a single destination allowing analysis on a large group of business data Creating a new HIPAA file is a more complex task but still within the reach of a SQL aware business analyst The sample database included with the Chiapas EDI distribution presents a small amount of mock claims and eligibility data rows as well as a SQL View for each 5010 transactions These views transform the mock healthcare data into a form Chiapas EDI can accept to project a HIPAA compliant EDI file The well documented transformations included within the sample SQL views provide a solid foundation for creating new outbound transactions Chiapas Studio is a powerful tool for developing and testing new trading partner transactions Once it is time to go to production Chiapas EDI contains a Windows Workflow 4 based automation system c
59. Date Hierarchical Transaction BHT 5 Beginning of STHDR_S 2_BHT 5_TS_CREATN_TIM Transaction Set Creation Time Hierarchical Transaction BHT 6 Beginning of STHDR 502 06 ID Claim Identifier Hierarchical Transaction SEO1 Transaction Set STHDR S06 SEO1 SEG CT Transaction Segment Count Trailer 5 02 Transaction Set STHDR 506 5 02 Transaction Set Control Number Trailer Loop SUBMITTER NAME 1000A NM103 Submitter Name L1000A SO1 NM103 SUBMTR LAST ORG NM Submitter Last or Organization Name Non OVL NONPRSN ENTY Person Entity NM109 Submitter Name L1000A 501 109 SUBMTR ID Submitter Identifier Electronic Transmitter 4 Identification Number ETIN PERO2 Submitter EDI L1000A SO2 PERO2 CONTCT NM Submitter Contact Name Contact Information 4 Submitter EDI L1000A 502 4 COMM NR OVL TELPHN Communication Number Telephone Contact Information CHIAPAS EDI 2012 USER MANUAL Loop 1000B NM103 NM109 Loop 2000A HL 1 Loop 2010AA NM103 N301 N401 N402 N403 REF02 Loop 2000B HLO1 HLe2 HLO4 SBRO1 SBRO2 SBRe9 Loop 2010BA NM103 NM104 NM109 301 01 902 03 DMGO2 RECEIVER NAME Receiver Name Receiver Name BILLING PROVIDER HIERARCHICAL LEVEL Billing Provider Hierarchical Level BILLING PROVIDER NAME Billing Provider Name Billing Provider Address Billing Provider City State ZIP
60. ED_EVENT Unnamed Trigger Delete Si Trigger Info Polling Info Schedule Info Event History IEW awi ua Delete Unnamed Trigger E Enabled Poll Interval 30 6 Double click in the Workflow File field and in the resulting Open File Dialog select the file C chiapas xaml simpleEncodePipeline xaml 7 Press the Polling Info pane 8 Leaved the Scheduled Poll selected In the first textbox Data01 type in vw Export 270 b In the second textbox Data02 type in CAchiapasV270 text CHIAPAS EDI 2012 USER MANUAL Page 90 9 Press Save 10 Return to the Trigger Info tab 11 Set the Enabled checkbox 12 Press Save In the CAchiapas directory a new file should appear Since in this configuration Chiapas will create new files every 30 seconds you should disable it by toggling the Enabled checkbox and Saving again Now that we see what it does we should investigate how it does it To see the next step go to the Windows menu option and select Workflow Interface Once there select File Open and open C chiapas xaml simpleEncodePipeline xaml On the left you will see a toolbar filled with valid Chiapas EDI workflow activities and in the center you will see the stacked activities that comprise the workflow itself CHIAPAS EDI 2012 USER MANUAL Page 91 CGateContext From top to bottom A CGateArg The automation system allows the user to pass
61. ENDR ID OVL MUTLY D Interchange Sender ID Mutually Defined Control Header EFND ID 08 Interchange OEISA 501 ISAO8 RECVR ID OVL MUTLY D Interchange Receiver ID Mutually Defined Control Header EFND ID ISA09 Interchange OEISA 501 15409 DT Interchange Date Control Header ISA10 Interchange OEISA 501 ISA10 Interchange Time Control Header ISA11 Interchange OEISA 501 ISA11 REPTN SEPRTR Repetition Separator Control Header ISA12 Interchange OEISA 501 ISA12 VERSN NR Interchang Control Version Number Control Header ISA13 Interchange OEISA 501 ISA13 Interchange Control Number Control Header ISA14 Interchange OEISA 501 ISA14 REQ Acknowledgment Requested Control Header ISA15 Interchange OEISA 501 ISA15 USG IND Interchange Usage Indicator Control Header ISA16 Interchange OEISA 501 ISA16 SUBELE SEP Component Element Separator Control Header IEAO1 Interchange OEISA 503 IEAO1 GS Number of Included Functional Groups Control Trailer CHIAPAS EDI 2012 USER MANUAL Page 115 IEAO2 Interchange OEISA 503 2 ICN Interchange Control Number Control Trailer Loop GROUP HEADER GSHDR 6502 Functional Group GSHDR 501 GSO2 APP SENDR CD Application Senders Code Header 6503 Functional Group GSHDR 501 503 APP RECVR CD Application Receivers Code Header 6504 Functional Group GSHDR 501 6504 DT Date Header GS05 Functional
62. EST NULL SANFRANCISCO 94117 4155551204 6 6 DELORES PEAS 987654325 19700404 F 222FST NULL SANFRANCISCO 94117 NULL 2 E PENELOPE HASHBROWNS 987654326 19600303 F 333GST NULL SANFRANCISCO CA 94117 4155551205 8 8 EDWIN PASTA 987654327 19801010 444H ST NULL SANFRANCISCO CA 94117 NULL 9 5 LARRY SANDWICH 987654328 2000 01 01 M 5551ST NULL SANFRANCISCO CA 94117 4155551206 10 10 NAOMI BREAD 987654329 1950 04 04 F 123JST NULL SANFRANCISCO 94117 4155551207 Now here s to view the roster of providers included in the mock data SELECT TOP 10 FROM PROVIDER NPI ID COMPANY NM FIRST NM LAST NM 001 ADD2 CITY STATE ZIP CD CONTACT NM 1 i NULL DOOLITTLE HOSPITAL NULL NULL 123 AST NULL SANFRANCISCO CA 94117 NIXON 2 2 NULL NULL WINDING ROAD NULL NULL 456 B ST NULL SANFRANCISCO CA 94117 FORD 3 NULL NULL BEST PRACTICE CLINIC NULL NULL 789C ST NULL SANFRANCISCO CA 94117 CARTER 4 4 NULL NULL CHEAPEST HMO NULL NULL 199 D ST NULL SANFRANCISCO CA 94117 GRANT 5 5 273801950 NULL CHIAPAS EDI TECH NULL NULL 126CARDENAS AVE NULL SANFRANCISCO CA 94132 RICHARD TEMPS 6 6 273801950 123400001 NULL LAWRENCE AVOCADO 999ZST NULL SANFRANCISCO CA 94132 ELDRITCH POWERS Now to bring up the mock claims information SELECT FROM CLAIM HDR HDR INNER JOIN CLAIM DTL DTL ON HDR CLAIM ID DTL CLAIM ID CHIAPAS EDI 2012 USER MANUAL Page 12 CLAIM ID PROV ID MEM ID PATNT ACCT FAC TYP CD DIAG CD SEC DIAG CD STATUS ADJUDCTN_DT CLAIM ID
63. Flat register where the preceding actions have decoded the incoming 837 Professional EDI file and transformed it into a two dimensional table representation By clicking on the various cells of the table mapping information is projected onto the pulldown textboxes in the upper left Now let s get this information into a SQL database table where the business information within this EDI file can be easily queried Click on the Flat tab on the left Data I O pane Click on the Flat to Table radio button and then change the Table textbox to the following name TUTORIAL 837P EXPORT The pane should look like this i ERR Now press the Execute button The oe Tabie sw Excel TUTORIAL_837P_EXPORT table will be created and populated Flat To Table Execute Table to Flat with the data SQL Server Data Source 2258 If you have a group of files of the same file format and you would like to merge the data into a single table you can use the Merge button instead of the Execute button Any business data where the Table mappings are common between the destination table and the loaded data will be inserted into the new table Any mappings in the loaded data that are not present within the destination table will be flagged as a message For now let s proceed to querying the newly created data Assuming that you have SQL Server Management Studio on the workstation open it up and
64. Group GSHDR 501 GSO5 Time Header GS06 Functional Group GSHDR 501 6506 Group Control Number Header 6508 Functional Group GSHDR 501 GSO8 VERS ID CD Version Release Industry Identifier Code Header GEO1 Functional Group GSHDR S03 GEO1 TS CT Number of Transaction Sets Included Trailer GE 2 Functional Group GSHDR_S 3_GE 2_GCN Group Control Number Trailer Loop TRANSACTION SET STHDR HEADER STO2 Transaction Set STHDR 501 STO2 CONTRL NR Transaction Set Control Number Header STe3 Transaction Set STHDR 501 STO3 IMPLMNTN CONVNTN REFN Implementation Convention Reference Header BGNe1 Beginning Segment STHDR 502 BGNO1 TS PURPS CD Transaction Set Purpose Code BGNO2 Beginning Segment STHDR 502 BGNO2 TS REF NR Transaction Set Reference Number BGN 3 Beginning Segment STHDR 502 BGNO3 TS CREATN DT Transaction Set Creation Date BGNO4 Beginning Segment STHDR 502 BGNO4 TS CREATN Transaction Set Creation Time BGN 8 Beginning Segment STHDR 502 BGNO8 CD Action Code SEQ1 Transaction Set STHDR S10 SEO1 SEG CT Transaction Segment Count Trailer 5 02 Transaction Set STHDR S10 SEO2 Transaction Set Control Number Trailer Loop SPONSOR NAME 1000A N102 Sponsor Name L1000A SO1 N102 PLAN SPONSR NM Plan Sponsor Name N104 Sponsor Name L1000A 501 N104 SPONSR ID OVL FED Sponsor Identifier Federal Taxpayer s X ID NR Identification Number Loop PAYER 1000B N102 Payer L1000B SO1 N102 INSR NM Insurer Name N104 Payer L1000B 501 N104
65. HIPAA Implementation Guide we would see the following relationship between the loops These relationships describe the KEY ID present within each row in each table it being the KEY ID of parent loop iteration When there is a complicated transaction however it can be difficult to establish these relationships correctly This is the function of the Export View button it will create a view on the specified destination database called vw Prefix This view projects the hierarchical data into a two dimensional format the same as the Flat register DB Tables to HKey This option tells Chiapas EDI to scan the source database for tables matching both the specified prefix and each of the loops that belong to the specification indicated in the first ISA loop mapping and then load the HKey data from these tables HKey to DB Tables As indicated above Chiapas EDI storages all HKey register data to a number of database tables All fields will have type VARCHAR 200 and every row contains both the KEY ID row index and PAR KEY ID parent row index DB Type Only SQL Server and Sqlite are supported for these operations other DB types will generate an error Data Source Database connection string CHIAPAS EDI 2012 USER MANUAL Page 32 Prefix Several letters that will prefix the database table names as described above Execute Button Runs the specified action against the database Export View Create
66. HLO1 HIERCHCL ID NR L2010AA 501 NM103 LAST ORGL NM OVL ONPRSN_ENTY L2010AA 502 N301 BILNG PROV ADRS LIN L2010AA 503 401 BILNG PROV CITY NM L2010AA 503 N402 STAT PROVNC CD L2010AA 503 N403 POSTL ZON ZIP CD L2010AA 504 REFO2 ID NR OVL EMPLYR I L2000B 501 HLO1 HIERCHCL ID NR L2000B 501 HLO2 HIERCHCL PARNT ID NR L2000B 501 HLO4 HIERCHCL CHILD CD L2000B 502 SBRO1 PAYR RESP SEQNC NR L2000B 502 SBRO2 INDVDL REL CD L2000B 502 SBRO9 FILNG IND CD L2010BA 501 NM103 SUB LNAME OVL PERS L2010BA 501 NM104 SUB FNAME L2010BA 501 NM109 PRIMRY ID OVL MEM ID NR L2010BA 502 N301 ADRS LIN NM103 Submitter Name NM109 Submitter Name R PER 2 Submitter EDI Contact Information PERO4 Submitter EDI Contact Information Loop RECEIVER NAME 1000B NM103 Receiver Name NM109 Receiver Name R Loop BILLING PROVIDER 2000A HIERARCHICAL LEVEL HLO1 Billing Provider Hierarchical Level Loop BILLING PROVIDER 2010AA NAME NM103 Billing Provider Name 361 Billing Provider Address N401 Billing Provider City State ZIP Code 02 Billing Provider City State ZIP Code N403 Billing Provider City State ZIP Code REF02 Billing Provider Tax D NR Identification Loop SUBSCRIBER 2000B HIERARCHICAL LEVEL HLei Subscriber Hierarchical Level HLe2 Subscriber Hierarchical Level HLO4 Subscriber Hierarchical Level SBRO1 Subscriber Information CD SBRO2 Subscriber Information SBRO9 Subscrib
67. IAPAS EDI 2012 USER MANUAL Member Table This table represents a mock membership that is used in the various sample transactions Column Name Data Type Purpose MEM ID INT PK Unique Member Adjustment Identifier FIRST NM VARCHAR 50 First Name LAST NM VARCHAR 50 Last Name SSN ID VARCHAR 20 Social Security Number BIRTH DT DATE Birth Date GENDER VARCHAR 1 Gender ADD1 VARCHAR 75 Address Line 1 ADD2 VARCHAR 75 Address Line 2 CITY VARCHAR 50 City STATE VARCHAR 2 State ZIP CD VARCHAR 20 Zip Code PHONE NR VARCHAR 20 Phone Number Page 84 CHIAPAS EDI 2012 USER MANUAL Page 85 Member Eligibility Table This table is used to encode a Member s eligibility history and is used by the 834 Eligibility extract as a data source Column Name Data Type Purpose MEM ELIG ID PK Unique Member Eligibility Identifier MEM ID INT Foreign Key to the Member table STATUS VARCHAR 10 Eligibility status FROM DT DATE Eligibility From Date TO DT DATE Eligibility To Date CHIAPAS EDI 2012 USER MANUAL Provider Table Page 86 This table storages a number of mock providers that are used through a number of the sample extracts Column Name PROV ID TAX ID NPI ID COMPANY NM FIRST NM LAST NM ADD1 ADD2 CITY STATE ZIP_CD CONTACT_NM WORK_PH EMAIL Data Type INT PK VARCHAR 15 VARCHAR 12 VARCHAR 50 VARCHAR 20 VARCHAR 20 VARCHAR 75 VARCHAR 75
68. IDE This Quick Start Guide is oriented to quickly accessing three core features of the Chiapas EDI 2012 product Decoding Encoding and Automation Decoding is focused on taking one of the included sample HIPAA files through the steps of converting it to a database table Encoding focuses on converting some of the included mock healthcare data to a new HIPAA file This covers the most basic usage patterns of Chiapas EDI Both of these examples start with launching Chiapas Studio located at the following path C chiapas bin ChiapasStudio exe The tab group on the left is called the Data I O pane the middle is called the Register panne and the rightmost tab group is called the SegPool pane DECODING A basic operation of Chiapas EDI 2012 is the ability to convert an arbitrary 4010 or 5010 EDI file to a database table This section will guide you through the process step by step Flat HKey SegPool Log When you first open Chiapas Studio the left side of DB Table CSV Excel the screen is occupied by the Data I O pane This Flat To Table pane allows the user to directly control loading or saving information from the Chiapas Studio DB Type SQL Server zj environment Data Source Ems urces Database chiapasData Trusted Connection true Emm To start press on the SegPool tab Flat HKey SegPool Log File 999 SegPool to File Execute File to SegPool CR LF
69. IN L2200B 501 TRNO2 TRANSCTN BAT CH NR L2200B 502 5 01 01 HLTH CR S TATS CAT CD L2200B 502 STCO1 02 HLTH CR S TATS CD L2200B 502 STCO2 STATS EFF DT L2200B S02 STCO3 ACTN CD L2200B 502 5 04 TOTL SUBMTD CHGS WORK L2200B 503 QTYO2 TOTL ACCPTD QTY Page 107 Transaction Set Control Number Implementation Convention Reference Reference Identification Transaction Set Creation Date Set Creation Time Transaction Transaction Type Code Transaction Set Control Number Hierarchical Child Code Information Source Non Person Entity Information Source Primary Identifier Payor Identification Last or Organization Name Information Source Application Trace Identifier Information Source Receipt Date Received D8 Information Source Process Date Process D8 Hierarchical Child Code Information Receiver Last or Organization Name Non Person Entity Information Receiver Primary Identifier Electronic Transmitter Identification Number ETIN Claim Transaction Batch Number Health Care Claim Status Category Code Health Care Claim Status Code Status Information Effective Date Action Code Total Submitted Charges for Work Total Accepted Quantity CHIAPAS EDI 2012 USER MANUAL Page 108 Qrve2 Total Rejected Quantity L2200B 504 QTYO2 TOTL REJECTD QTY Total Rejected Quantity Specification 5010 278 REQ Reference Segment
70. INSR ID CD OVL FED Insurer Identification Code Federal AX ID NR Taxpayer s Identification Number Loop MEMBER LEVEL 2000 DETAIL INSO1 Member Level L2000 SO1 INSO1 MEM IND Member Indicator Detail 502 Member Level 12000 501 INSO2 INDVDL REL CD Individual Relationship Code Detail INS 3 Member Level L2000 SO1 INSO3 MAINTNC TYPE CD Maintenance Type Code Detail INS 5 Member Level L2000 SO1 INSO5 BENFT STATS CD Benefit Status Code Detail INS 8 Member Level L2000 SO1 INSO8 EMPLYMNT STATS CD Employment Status Code Detail REF02 Subscriber 12000 502 REFO2 SUB ID OVL SUB NR Subscriber Identifier Subscriber Number Identifier REF 2 Member Policy 12000 503 REFO2 POLCY NR OVL Member Group or Policy Number Group or Number GRP POLCY NR Policy Number REFO2 Member 12000 504 REFO2 SUPP ID OVL CLIENT R Member Supplemental Identifier Client Supplemental EPRTNG CATGRY Reporting Category Identifier DTP 3 Member Level L2000_S 5_DTP 3_STATS_NFO_EFF_DT_OVL Status Information Effective Date Dates _ELIG_BEGN_D8 Eligibility Begin D8 CHIAPAS EDI 2012 USER MANUAL Page 116 Loop MEMBER NAME 2100A NM103 Member Name L2100A IL 501 NM103 LNAME OVL PE Member Last Name Person RSN NM104 Member Name L2100A IL 501 NM104 MEM FNAME Member First Name PERO4 Member L2100A IL 502 PERO4 COMM NR OVL HOM Communication Number Home Phone Number Communications PHON NR Numbers N301 Membe
71. INSTALLATION Chiapas EDI 2012 is distributed as a single MSI file To run it double click on it and it will automatically install all components to the C drive under the C chiapas directory Next launch the executable located at C chiapas db Follow the instructions to add the chiapasData SQL database to the SQL Server instance This contains all of the tables necessary for Chiapas EDI s automation system as well as the mock healthcare data and SQL Views for creating new outbound transactions Finally the automation background service needs to be configured Press Start gt Right Click on Computer select Manage Go to Configuration Services Right click Properties on ChiapasService Switch to the LogOn tab then fill in the 100 On As information with login and password information for an account with Administrator permissions Return to the General Tab press Start to start running the automation service CHIAPAS EDI 2012 USER MANUAL Page 7 UPDATES Your Chiapas EDI distribution may occasionally be updated as part of your ongoing maintenance agreement All Chiapas EDI downloads are controlled via a single SecureFTP server accessed at sftp chiapas edi org Login information is provided to you along with your Chiapas EDI 2012 license If your corporation lacks the ability to log into Secure FTP sites a well established client can be found at http winscp net CHIAPAS EDI 2012 USER MANUAL Page 8 QUICK START GU
72. ISA 503 2 ICN Interchange Control Number Trailer Loop GROUP HEADER GSHDR 6502 Functional Group GSHDR 501 6502 APP SENDR CD Application Senders Code Header GS03 Functional Group GSHDR 501 6503 APP RECVR CD Application Receivers Code Header 6504 Functional Group GSHDR 501 6504 DT Date Header GS05 Functional Group GSHDR 501 6505 Time Header GS06 Functional Group GSHDR 501 6506 Group Control Number Header GEO1 Functional Group GSHDR S03 GEO1 TS CT Number of Transaction Sets Included Trailer GEO2 Functional Group GSHDR S03 GE0O2 Group Control Number Trailer Loop TRANSACTION SET STHDR HEADER 5 02 Transaction Set STHDR 501 STO2 CONTRL NR Transaction Set Control Number Header STO3 Transaction Set STHDR 501 STO3 IMPLMNTN GUID VERS Implementation Guide Version Name Header N NM BHTO1 Beginning of STHDR 502 BHTO1 STRUCTR CD Hierarchical Structure Code Hierarchical Transaction BHT 2 Beginning of STHDR 502 BHTO2 TS PURPS CD Transaction Set Purpose Code Hierarchical Transaction BHT03 Beginning of STHDR S02 BHTO3 SUBMTR TRANSCTN I Submitter Transaction Identifier Hierarchical D Transaction CHIAPAS EDI 2012 USER MANUAL Page 109 BHT04 Beginning of STHDR 502 04 TS CREATN DT Transaction Set Creation Date Hierarchical Transaction BHT 5 Beginning of STHDR_S 2_BHT 5_TS_CREATN_TIM Transaction Set Creation Time Hier
73. N Claim Information Claim Information Claim Information Claim Information Claim Information Claim Information Claim Information Statement Dates Institutional Claim Code Institutional Claim Code Institutional Claim Code Institutional Claim Code Institutional Claim Code ATTENDING PROVIDER NAME Attending Provider Name Attending Provider Name Attending Provider Secondary Identification SERVICE LINE NUMBER Service Line Number Institutional Service Line Institutional Service Line Institutional Service Line Institutional Service Line L2010BA 504 DMGO3 GENDR CD L2010BB 501 NM103 PAYR NM OVL NONPRS N ENTY L2010BB 501 109 PAYR ID OVL PAYR I D L2010BB 502 N301 ADRS LIN L2010BB 503 N40O1 CITY NM L2010BB 503 N402 STAT CD L2010BB 503 N403 PAYR POSTL ZON ZIP L23 _S 1_CLM 1_PATNT_CONTRL_NR 12300 501 2 12300 501 CLMO5 O1 FACLTY TYPE CD 12300 501 5 FREQNCY CD OV L UBC FORM L2300 SO1 CLMO7 ASGNMNT PLAN PARTCPT N CD 12300 501 8 BENFTS ASGNMNT CERT IND 12300 501 CLMO9 RELS NFO CD 12300 503 DTPO3 STATMNT FROM TO DT O VL STATMNT RD8 12300 506 CL101 ADMSN TYPE CD 12300 506 CL102 5 SOURC CD 12300 506 CL103 PATNT STATS CD L2300 S26 HIO1 02 PRINCPL DIAG CD OV L ICD9CM PRINCPL DIAG L2300 S31 HIO1 02 OTHR DIAG OVL ICD9 CM DIAG L2310A 501 NM103 PROV LNAME OVL PERS N L2310A 501 NM104
74. Number Trailer Loop TRANSACTION SET STHDR HEADER STO2 820 Header STHDR 501 STO2 TS CONTRL NR Transaction Set Control Number ST 3 820 Header STHDR_S 1_ST 3_IMPLMNTN_CONVNTN_REFNC Implementation Convention Reference BPRO 2 Financial STHDR S02 BPRO2 TOTL PREM PMT AMT OVL Total Premium Payment Amount Remittance Information REMTNC NFO ONLY Information Only BPRO4 Financial STHDR_S 2_BPR 4_PMT_METHD_CD Payment Method Code Information BPR10 Financial STHDR S02 BPR10 PAYR ID Payer Identifier Information BPR16 Financial STHDR 502 BPR16 IS EFT EFF DT Check Issue or EFT Effective Date Information TRN 1 Reassociation STHDR_S 3_TRN 1_TYPE_CD Trace Type Code Trace Number TRNO2 Reassociation STHDR S03 TRNO2 CHK EFT TRAC NR Check or EFT Trace Number Trace Number SEO1 Transaction Set STHDR S15 SEO1 SEG CT Transaction Segment Count Trailer CHIAPAS EDI 2012 USER MANUAL Page 114 5 02 Transaction Set STHDR S15 5 02 Transaction Set Control Number Trailer Loop PREMIUM RECEIVERS 1000A NAME N102 Premium L1000A SO1 N102 LAST ORG NM Premium Receiver s Last or Organization Name Receiver s Name N104 Premium L1000A 501 N104 RECVR ID CD _ Premium Receiver s Identification Code Receiver s Name FED TAX ID NR Federal Taxpayer s Identification Number Loop PREMIUM PAYERS 1000B NAME N102 Premium Payer s L1000B 501 N102 PAYR NM Premium Payer Name Name N104 Premium Payer s L1000B
75. P06 Claim Payment 12100 501 CLPO6 FILNG IND CD Claim Filing Indicator Code Information CLPO7 Claim Payment L2100 SO1 CLPO7 PAYR CLM CONTRL NR Payer Claim Control Number Information NM103 Patient Name 12100 503 NM103 LNAME Patient Last Name NM104 Patient Name 12100 503 NM104 Patient First Name NM109 Patient Name 12100 503 NM109 PATNT ID OVL MEM ID Patient Identifier Member Identification NR Number DTMO2 Statement From or 12100 S14 DTMO2 DT OVL STATM Claim Date Claim Statement Period Start To Date NT PERD START DTMe 2 Statement From or 12100 S14 DTMO2 IO2 DT OVL 5 Claim Date Claim Statement Period End To Date TATMNT PERD END 02 Claim L2100 S18 AMTO2 CLM SUPP NFO AMT OVL Claim Supplemental Information Amount Supplemental COVG AMT Coverage Amount Information 01 02 Claim L2110 SO1 SVCO1 02 ADJDCTD PROC CD O Adjudicated Procedure Code Health Care Supplemental VL 5 CD Financing Administration Common Procedural Information Coding System HCPCS Codes Loop SERVICE PAYMENT 2110 INFORMATION SVC 2 Service Payment 12110 501 SVCO2 LIN ITM CHG AMT Line Item Charge Amount Information 5 Service Payment 12110 501 SVCO3 LIN ITM PROV PMT AMT Line Item Provider Payment Amount Information SVC 5 Service Payment L2110_S 1_SVC 5_UNTS_SVC_PD_CT Units of Service Paid Count Information DTM 2 Service Date 12110 502 DTMO2 SVC DT OVL SVC Service Date Serv
76. Qualifier Name L NM103 Information Receiver L2100B 1 501 NM103 NFO RECVR LAS Information Receiver Last or Organization Name Name ORG NM NM109 Information Receiver L2100B 1P SO1 NM109 NFO RECVR ID Information Receiver Identification Number Name NR OVL FED TAX ID NR Federal Taxpayer s Identification Number Loop SUBSCRIBER LEVEL 2000C HLO1 Subscriber Level L2000C 501 HLO1 HIERCHCL ID NR Hierarchical ID Number HLO2 Subscriber Level L2000C 501 HLO2 HIERCHCL ID Hierarchical Parent ID Number NR 04 Subscriber Level L2000C 501 HLO4 HIERCHCL CHILD CD Hierarchical Child Code Loop SUBSCRIBER NAME 2100C NM103 Subscriber Name L2100C 501 NM103 SUB LNAME Subscriber Last Name NM104 Subscriber Name 12100 _501 104 50 Subscriber First Name NM109 Subscriber Name L2100C 501 109 PRIMRY ID OVL ME Subscriber Primary Identifier Member M ID NR Identification Number N301 Subscriber Address L2100C 503 301 ADRS LIN Subscriber Address Line N401 Subscriber City 12100 504 401 Subscriber City Name State ZIP Code 02 Subscriber City L2100C 504 402 STAT CD Subscriber State Code State ZIP Code 03 Subscriber City L2100C 504 NA403 SUB POSTL ZON ZIP Subscriber Postal Zone or ZIP Code State ZIP Code _cD DTP 3 Subscriber Date L2100C S10 DTPO3 DT TM PERD OVL P Date Time Period Plan D8 LAN D8 DTP03 Subscriber Date L2100C S10 DTPO3 102 DT TM PERD 0 Date Time Period Eligibility Begin D8 VL ELIG
77. RCHIVE DIRECTORY EVENT Full path to the Workflow XAML file that is executed as part of the event spawned by this trigger This is the number of seconds the background ChiapasService will wait between checks for this trigger Caution should be exercised when setting this to a value less than 60 Name of the trigger Trigger Data 01 Trigger Data 02 Trigger Data 03 Trigger Data 04 Trigger Data 05 Timestamp when the trigger was created CHIAPAS EDI 2012 USER MANUAL Sample Object Schema CLAIM HDR CLAIM DTL CLAIM ID 4 i CLAIM DTL ID PROV ID CLAIM ID MEM ID MEMBER ELIG MEM ID 4 MEM ELIG ID MEM ID Page 80 CLAIM ADj CLAIM ADJ ID CLAIM DTL IO PROVIDER t PROV ID In order to demonstrate the process of encoding different specifications Chiapas EDI 2012 stores mock member claims and provider data in this schema As the generation of EDI files is linked to managed care these tables were designed as a miniature managed care database In this way the twelve 5010 extract views that generate sample files are more closely aligned with the extracts developers will need to create in order to support their business processes CHIAPAS EDI 2012 USER MANUAL Page 81 Claim Header Table This table represents Claim Header data for the mock claims in the distribution database Column Name Data Type CLAIM ID INT PK PROV ID INT MEM ID INT PATNT ACCT NR VARCHAR 50 FAC TYP CD VARCHAR 2
78. TL ZON ZIP C Payer Postal Zone or ZIP Code State ZIP Code D PERO2 Payer Technical L1000A 506 PERO2 PAYR TECHNCL CONTCT Payer Technical Contact Name Contact _NM Information PER 4 Payer Technical L10 0A_S 6_PER 4_PAYR_CONTCT_COMNCTN Payer Contact Communication Number Telephone Contact _NR_OVL_TELPHN Information Loop PAYEE 1000B IDENTIFICATION N102 Payee L1000B SO1 N102 PAY NM Payee Name Identification N104 Payee L1000B 501 N104 ID CD OVL FED TAX ID Payee Identification Code Federal Taxpayer s Identification _NR Identification Number N301 Payee Address L1000B 502 N301 ADRS LIN Payee Address Line N401 Payee City L1000B 503 401 CITY NM Payee City Name State ZIP Code N402 Payee City L1000B 503 402 STAT CD Payee State Code State ZIP Code N403 Payee City L1000B 503 403 PAY POSTL ZON ZIP CD Payee Postal Zone or ZIP Code State ZIP Code Loop HEADER NUMBER 2000 LX 1 Header Number 12000 501 LXO1 ASGND NR Assigned Number CHIAPAS EDI 2012 USER MANUAL Page 118 Loop CLAIM PAYMENT 2100 INFORMATION CLPO1 Claim Payment 12100 501 CLPO1 CONTRL NR Patient Control Number Information CLPO2 Claim Payment L2100 SO1 CLPO2 STATS CD Claim Status Code Information CLPO3 Claim Payment L2100 SO1 CLPO3 TOTL CLM CHG AMT Total Claim Charge Amount Information CLPOA Claim Payment 12100 501 4 PMT AMT Claim Payment Amount Information CL
79. This activity needs to be present prior to encoding of the file for these formatting options to be applied on the final outgoing file CGateHKeyFromFlat Activity This activity will translate the Flat register to the HKey register transforming the two dimensional column row layout of the Flat register into the hierarchical format of the HKey register CGateHKeyToFlat The counterpart to the CGateHKeyFromFlat activity this will transform the HKey to the two dimensional Flat register Internally the HKey register is pushed into a series of SQLite memory tables and then transformed via a SQL view to a flat representation of the data see the Export View function under the HKey Data I O Interface tab for more information CHIAPAS EDI 2012 USER MANUAL Page 59 CGateXltEncode This activity will transform a loaded HKey register into the SegPool register If certain required elements are not supplied the encoder will attempt to default them to certain values The Chiapas Gate Encoder can generate values for the following segments and elements Defaulted Element 15 01 15402 15 03 15 04 15 05 15 06 15 07 ISA08 15409 15410 15 11 15412 15 13 15 14 15 15 15416 6501 6502 Defaulted Value 00 Whitespace 00 Whitespace Sender Qual Value set in the Encounter Data Activity Sender ID Value set in the Encounter Data Activity Receiver Qual Value set in the Encounter Data Activity Receiver ID Value set
80. UAL Page 23 CHIAPAS REGISTERS Internally Chiapas EDI 2012 contains a State object that is instanced every time Chiapas Studio is opened or a new Automation activity is run This State object contains five registers SegPool This contains a representation of a raw 4010 5010 EDI message It is a container for the elements and segments as well as basic information like line termination element and composite element and segment separators When an EDI message is loaded it will automatically set the values for the separators When set by the user these values will be ignored until the HKey Encode action is executed SegPoolAck This is a container that contains the segments and elements for a 999 Acknowledgement transactions It can be generated once a decode operation is complete to show the status of the decode operation which can then be saved to a new 999 file and returned to a trading partner to show successful receipt of their file It can also be loaded and used in Chiapas Studio to indicate the error messages within a file HKey This is a hierarchical representation of the business data within an X12 message Internally the HKey register is divided by loops with the mappings in each loop iteration aggregated together Each iteration also has an index to the iteration of the parent loop Thus each HKey stores containers for the ISA envelope loop the GS loop the ST loop and one for each discrete loop that appears in the transa
81. ansaction containing 24 or more iterations and is typically the most fundamental required data segment for that specification For a Claims file this is the Claim Line segment and for eligibility transactions this would be a 2300 Health Coverage loop This is similar to the logical arrangement of data in most databases and data warehouses In certain scenarios loops will repeat to convey information associated with a claim and not with a specific claim line Chiapas Gate maps these loops laterally and assigns an iteration counter much like the one used to convey repeating segments In this case however the iteration counter will apply to both the loop and children loops In this way both a loop and its associated child loops are all bundled together One example where this can occur is with Loop 2320 Other Subscriber Information inside an 837 Institutional claim transaction Each of the ten loop iterations can themselves have up to eight different single iteration children loops To encapsulate this complexity an iteration counter is used to group the whole batch of loops and sub loops together L2330A 102 503 403 OTHR INSRD POSTL ZON ZIP CD CHIAPAS EDI 2012 USER MANUAL Page 22 This mapping represents the Other Subscriber ZIP Code belonging to a single instance of the 2330A Other Subscriber Name loop which is a child under the second iteration of its repeating parent loop 2320 Other Subscriber Information CHIAPAS EDI 2012 USER MAN
82. ansactions with enterprise systems with a focus on SQL Server databases Before we proceed into the details one may ask what is Chiapas EDI 2012 In simplest terms Chiapas EDI 2012 is a Windows based ANSI X12 4010 5010 EDI translation software with automation components EDI translation systems are focused on communicating internal business data with an external trading partner Within a single business there is no need for EDI because all of the information is integrated into the enterprise system However in the normal course of business many healthcare entities enter into contractual agreements where they must regularly exchange certain types of data like claims or eligibility Trading partners are required to transform their internal business data into an EDI message and securely transmit it to the other party who then extracts the business data from the message into a form they can use The 5010 format is actually over a dozen different transaction specifications that defines over ten thousand individually defined business elements Even though this is a federally regulated specification the exact description of the protocol needs to be licensed by the Washington Publishing Company who publish the specifications on behalf of the ASC X12 Accredited Standards Committee who own the specifications Chiapas EDI 2012 contains sufficient information about these specifications to translate any 5010 EDI message into a CSV XML or database table ev
83. apable of creating a completely hands free process using a visual design language and event driven triggers Encrypted file uploads are supported via the included WinSCP SecureFTP client to ensure PHI information is safeguarded at all times To install Chiapas EDI to your 64 bit Windows PC and see the minimum system requirements please see the Install Guide CHIAPAS EDI 2012 USER MANUAL Page 5 To get started using the features please see the Quick Start Guide This will show you how to use Chiapas Studio and introduce basic concepts related to decoding encoding and automation For a thorough coverage of all of the functionality within Chiapas Studio and a thorough explanation of the Chiapas Gate Intermediate Format that underlies the core translation engine see the User Reference Finally the Technical Reference gives in depth coverage of the data structures and Windows Workflow 4 Activities used to develop complex new business automation and trading partner transactions CHIAPAS EDI 2012 USER MANUAL Page 6 INSTALL GUIDE REQUIREMENTS Chiapas EDI 2012 has the following requirements 64 Bit Windows Operating System Windows 7 Windows Server 2008 R2 Windows 8 or Windows Server 2012 4 0 Although installed by default on Windows 7 and 8 it is normally an optional Feature on Server operating systems SQL Server 2008 R2 Express or Standard versions 8GBof RAM Local Administrator rights when installing
84. ar to the Data I O Interface within Chiapas Studio and can import export data from many different sources The labels will change according to the Action that is selected ErrLog DB Table This will export the current error log to a database table using the specified DB Type Connection String and Data Table arguments ErrLog CSV File Exports the error log to a CSV file specified in the File Path textbox Flat DB Table Exports a loaded Flat register to a database table If the database type selected is SQLite or SQL Server the destination table will be created if it doesn t exist Then all rows of the Flat object will be inserted If the table previously exists and the schema of the Flat register doesn t match the destination database table no rows will be inserted and an error will be logged For this situation the Merge activity is more appropriate CHIAPAS EDI 2012 USER MANUAL Page 56 Flat DB Table Loads the Flat register from a datababse table Note that it is possible to use a SQL SELECT statement in lieu of a table name here this is the only way to ensure the Encoder receives a sorted dataset if going from a raw database table Flat CSV File Flat CSV File Exports or imports the Flat register to a CSV file Flat Excel File Flat Excel File Exports or imports the Flat register to an Excel file The filename should end with either xls to use the Excel 2003 format or xlsx to use the Exc
85. archical Transaction SEO1 Transaction Set STHDR 504 SEO1 SEG Transaction Segment Count Trailer 5 02 Transaction Set STHDR S04 5 2 Transaction Set Control Number Trailer Loop UTILIZATION 2000A MANAGEMENT ORGANIZATION UMO LEVEL HLO1 Utilization L2000A 501 HLO1 HIERCHCL ID NR Hierarchical ID Number Management Organization UMO Level Loop UTILIZATION 2010A MANAGEMENT ORGANIZATION UMO NAME NM102 Utilization L2010A 501 NM102 ENTY TYPE QUA Entity Type Qualifier Management L Organization UMO Name NM103 Utilization L2010A X3 501 NM103 UMO NM LAST O Utilization Management Organization UMO Management RG NM Name Last or Organization Name Organization UMO Name NM109 Utilization L2010A X3 501 109 ID CD OVL EMP Utilization Management Organization UMO Management LYR ID NR Identification Code Employer s Organization UMO Identification Number Name Loop REQUESTER LEVEL 2000B HLO1 Requester Level L2000B SO1 HLO1 HIERCHCL ID NR Hierarchical ID Number HL 2 Requester Level L2000B 501 HLO2 HIERCHCL PARNT ID Hierarchical Parent ID Number NR Loop REQUESTER NAME 2010B NM102 Requester Name L2010B 1P 501 102 TYPE QUA Entity Type Qualifier L NM103 Requester Name L2010B 1P 501 NM103 REQSTR LAST 0 Requester Last or Organization Name RG NM NM104 Requester Name L2010B 1P 501 104 REQSTR FNAME Requester First Name NM109 Requester Name L2010B 1 501 NM109 REQSTR ID OVL Requester Identifier Electronic T
86. as no bearing on the underlying registers working properly 3 Enable Flat Data Pane Again when working with large data sets disabling the display refresh can increase user interface performance Clear Notification Area This will reset the notifications window in the upper right hand corner Clear Messages This will clear the accumulated error and message logs Reset All This will clear all data registers and windows restoring the interface to a newly opened state CHIAPAS EDI 2012 USER MANUAL Page 44 Workflow Interface What is a workflow Chiapas Studio is useful to handle a lot of ad hoc tasks but it isn t an automation platform For that Chiapas EDI 2012 relies on a Microsoft technology called Windows Workflow Foundation 4 0 This technology consists of two parts a design studio to design new workflows and an engine platform to run them The workflows themselves are composed of Activities which are similar in visual appearance to a flowchart box Chiapas EDI 2012 includes 42 activities that cover all functionality present within Chiapas Studio as well as additional functions relating to shell commands databases SecureFTP and File I O transfers By stacking these in order the developer can create workflows to implement a number of different business processes relating to HIPAA files Automation Architecture The Chiapas EDI 2012 installation sets up a system service that waits in the background and per
87. ation Source Level INFORMATION SOURCE NAME Information Source Name Information Source Name TRANSMISSION RECEIPT CONTROL IDENTIFIER Transmission Receipt Control Identifier Information Source Receipt Date Information Source Process Date INFORMATION RECEIVER LEVEL Information Receiver Level INFORMATION RECEIVER NAME Information Receiver Name Information Receiver Name INFORMATION RECEIVER APPLICATION TRACE IDENTIFIER Information Receiver Application Trace Identifier Information Receiver Application Trace Identifier Information Receiver Application Trace Identifier Information Receiver Status Information Information Receiver Status Information Information Receiver Status Information Total Accepted Quantity STHDR 501 5702 CONTRL NR STHDR 501 STO3 IMPLMNTN CONVNTN R EFNC STHDR 502 REF ID STHDR 502 4 TS CREATN DT STHDR S02 BHTO5 TS CREATN STHDR S02 BHTO6 TRANSCTN TYPE CD STHDR 506 5 02 L2000A 501 HLO4 HIERCHCL CHILD CD L2100A PR 501 NM103 SOURC LAS T ORG NM OVL NON PERSN ENTY L2100A PR 501 NM109 NFO SOURC PRI MRY ID OVL PAYR ID L2200A 501 TRNO2 NFO 5 APPLCTN TRAC L2200A 502 DTPO3 DT TM PERD R ECVD D8 L2200A S03 DTPO3 NFO SRC PROCSS D T OVL PROCSS D8 12000 501 HLO4 HIERCHCL CHILD CD L2100B 501 NM103 NFO RECVR LAST 0 RG NM OVL NON PERSN ENTY L2100B SO1 NM109 NFO SOURC PRIMRY ID OVL ET
88. atus Response chiapas sample seed_278_req txt Health Care Services Review Request for Review C chiapas sample seed_278_resp txt Health Care Services Review Response C chiapas sample seed_820 txt Payroll Deducted and Other Group Premium Payment for Insurance Products C chiapas sample seed_834 txt Benefit Enrollment and Maintenance C chiapas sample seed_835 txt Health Care Claim Payment Advice C chiapas sample seed_837d txt Health Care Claim Dental C chiapas sample seed_8371 txt Health Care Claim Institutional C chiapas sample seed_837p txt Health Care Claim Professional The XAML directory contains all of the sample workflow files included with the distribution When linked to the scheduling system these represent out of the box automation solutions for a number of scenarios C chiapas xaml binDecoder 1 Workflow for the binDecoder automation example CHIAPAS EDI 2012 USER MANUAL Page 88 1 This is the default workflow opened whenever the defaultWorkflow xaml New Workflow menu option is selected within the Workflow Interface Es chtapas xa This encode workflow was designed to work with a simpleEncodePipeline xaml Scheduled automation trigger chiapasData Database Object Purpose BIN 834 5 BIN 837D 5 BIN 837I 5 The BIN objects are related to the binDecoder BIN 837P 5 workflow and are covered in the following section BIN LOG
89. be generated Unmerged Mapping followed by the CGIF field name that is being dropped Note that if mappings are present within the destination table but are not present in the source this will not generate any error messages Furthermore the destination table CHIAPAS EDI 2012 USER MANUAL Page 69 may contain non CGIF column names like FileName or CreateDate so that after the merge operation is complete the NULL default values of these columns can be updated to reflect the source file name and creation date of the record If you were to merge the CGIF schemas for an 8371 and 837P source file it would be possible to have a single queryable database table containing both Professional and Institutional files Arguments DestCnn Destination Connection This is the name of an existing open database connection DestTable Destination Table This must be the name of a table that already exists within the target database External I O Activities CGateXFEROpenSession This activity will open a WinSCP session that has been previously configured with the bundled WinSCP application Arguments SessionName name of the session as registered within the WinSCP Sessions interface CGateXFERCloseSession This activity closes the active WinSCP session CGateXFERPutFile This activity requires an open WinSCP session and will upload a local directory to the remote file system with the specified filename Arguments FileName Local
90. cal Parent ID Number _NR 04 Patient Event Level L2000E 501 HLO4 HIERCHCL CHILD CD Hierarchical Child Code 0 01 Health Care Services L2000E 504 UMO1 05 CATGRY CD Request Category Code Review Information UMe2 Health Care Services L2000E 504 UMO2 CERT TYPE CD Certification Type Code Review Information UMe3 Health Care Services L2000E 504 UMO3 TYPE CD Service Type Code Review Information 0 04 01 Health Care Services L2000E 504 UMO4 01 FACLTY TYPE CD Facility Type Code Review Information 0 04 02 Health Care Services L2000E 504 0 04 02 FACLTY CD QUAL Facility Code Qualifier Review Information HCRe1 Health Care Services L2000E 505 HCRO1 ACTN CD Action Code Review 2 Health Care Services L2000E 505 HCRO2 REVW ID NR Review Identification Number Review CHIAPAS EDI 2012 USER MANUAL Page 113 Specification 5010 820 Reference Segment Mapping Loop ISA GROUP HEADERS ISAe2 Interchange 50 OEISA 501 ISAO2 AUTH NFO OVL NO AU Authorization Information No Authorization Control Header TH NFO Information Present 5 04 Interchange OEISA 501 ISAO4 SEC NFO OVL NO SEC NF Security Information No Security Information Control Header 0 Present 5 06 Interchange OEISA 501 15 06 SENDR ID OVL MUTLY DE Interchange Sender ID Mutually Defined Control Header FND ID 5 08 OEIS
91. change Control OEISA 503 1 GS CT Number of Included Functional Groups Trailer IEAO2 Interchange Control OEISA 503 2 ICN Interchange Control Number Trailer Loop GROUP HEADER GSHDR 6502 Functional Group GSHDR 501 GSO2 APP SENDR CD Application Senders Code Header 6503 Functional Group GSHDR 501 6503 APP RECVR CD Application Receivers Code Header 6504 1 1 GSHDR_S 1_GS 4_DT Date Header GS 5 Functional Group GSHDR_S 1_GS 5_TM Time Header GS06 Functional Group GSHDR 501 6506 Group Control Number Header GEO1 Functional Group GSHDR S03 GEO1 TS CT Number of Transaction Sets Included Trailer GEO2 Functional Group GSHDR S03 GE02 Group Control Number Trailer Loop TRANSACTION SET STHDR HEADER 5 02 Transaction Set STHDR 501 STO2 CONTRL NR Transaction Set Control Number Header ST 3 Transaction Set STHDR_S 1_ST 3_IMPLMNTN_GUID_VERS Implementation Guide Version Name Header N_NM CHIAPAS EDI 2012 USER MANUAL Page 111 01 Beginning of STHDR 502 BHTO1 STRUCTR CD Hierarchical Structure Code Hierarchical Transaction BHT 3 Beginning of STHDR 502 BHTO3 SUBMTR TRANSCTN I Submitter Transaction Identifier Hierarchical D Transaction BHT04 Beginning of STHDR 502 BHTO4 TS CREATN DT Transaction Set Creation Date Hierarchical Transaction BHT 5 Beginning of STHDR 502 BHTO5 TS CREATN Transaction Set Creation
92. creen select Start Debugging CHIAPAS EDI 2012 USER MANUAL Page 48 At this stage you should now have a new file called 834 out csv in the C chiapas directory that contains CGateTransfer the 834 HIPAA file decoded to a flat file format The a full workflow is shown here IW j CGateContext File Path CAchiapas sample seed_ Variables To create a variable select the CGateContext activity Zl CGatexitDecode and open the Variables window by pressing Variables at the bottom of the screen You may select a default value for the variable and the variable is visible only within the scope you ve selected CGateHKeyToFlat 05 CGateTransfer Action Flat CSV File Imports FilePath CAchiapasVout csv Like any NET language you will need to add library references for accessing certain functions For example to create a FileInfo object first you will need to add a reference to System IO in this window Then you will be able to create new object instances for objects defined within that library and use all public functions as well CHIAPAS EDI 2012 USER MANUAL Page 49 Scheduler Interface The scheduler interface allows the user to see the status of currently defined triggers and events and configure new triggers Also it will show the event history associated with a trigger The Scheduler Interface works with these SQL database tables within the chiapasData database TSRC Th
93. ction Chiapas EDI 2012 State Raw EDI Raw EDI Message Message CHIAPAS EDI 2012 USER MANUAL Page 24 Flat This is a tabular column row representation of business data Each discrete mapped element is represented via a unique column that includes hierarchy positioning information embedded within the name The first column name in any Flat key also contains an extra prefix that describes which HIPAA specification this data belongs to Log This is an internal list of messages generating during all EDI parsing activities It is an output only register In the above diagram the five registers are listed in the second row with the next row showing the data formats usable with that register The three highlighted registers can be transformed to a neighboring register For example the SegPool register can be loaded from a Raw EDI message and then decoded into the HKey register Transforming the HKey to the SegPool register is called encoding Data within the HKey register can be shifted to the Flat register where it can then be saved to a SQL database table Excel spreadsheet or CSV file Chiapas EDI 2012 does not handle business level translations for example transforming a raw eight character date like 20120101 into a database Date column a database Instead it presents a fairly straightforward CGIF interface where internal business data can easily be projected into a form that Chia
94. cute Exports the Log register DB Type Database type to receive the Log register Data Source Connection string to the receiving database Table Name of the table to receive the Log register CSV Flat HKey SegPool Log Log to CSV Register The single option available DB Table CSV for the read only register Log to CSV File Execute Execute Exports the Log register CSV File CSV File CSV File to create when exporting the register CHIAPAS EDI 2012 USER MANUAL Page 37 Registers Interface The central two windows of Chiapas Studio are dedicated to providing a live view of the information contained within the Flat and HKey registers Because these displays are memory intensive they will not work to display data files larger than 10 MB even if the register loads successfully Tab This tab displays information about a loaded HKey register As described in a previous section the HKey storages hierarchical business information and is an intermediary between the SegPool register for interacting with HIPAA files and the Flat register for interacting with databases The information is displayed on screen in the form of an XML file Furthermore there are two controls that allow for translating the register to or from the Flat register Flat HKey This button translates the HKey to the Flat register Internally Chiapas EDI will convert the HKey to a series of in memory tables via SQLite and
95. dicator Control Header ISA16 Interchange OEISA 501 ISA16 SUBELE SEP Component Element Separator Control Header IEAO1 Interchange OEISA 503 IEAO1 GS Number of Included Functional Groups Control Trailer IEAO2 Interchange OEISA 503 2 ICN Interchange Control Number Control Trailer Loop GROUP HEADER GSHDR 6502 Functional Group GSHDR 501 GSO2 APP SENDR CD Application Senders Code Header GS03 Functional Group GSHDR 501 6503 APP RECVR CD Application Receivers Code Header 6504 Functional Group GSHDR 501 6504 DT Date Header GS05 Functional Group GSHDR 501 GSO5 Time Header GS06 Functional Group GSHDR 501 6506 Group Control Number Header 6508 Functional Group GSHDR 501 GSO8 VERS ID CD Version Release Industry Identifier Code Header GEO1 Functional Group GSHDR S03 GEO1 TS Number of Transaction Sets Included Trailer GE 2 Functional Group GSHDR_S 3_GE 2_GCN Group Control Number Trailer Loop TRANSACTION SET STHDR HEADER STO2 Transaction Set STHDR 501 STO2 CONTRL NR Transaction Set Control Number Header 01 Beginning of STHDR 502 BHTO1 STRUCTR CD Hierarchical Structure Code Hierarchical Transaction BHTO2 Beginning of STHDR 502 BHTO2 TS PURPS CD Transaction Set Purpose Code 1 1 1 Transaction BHT03 Beginning of STHDR 502 BHTO3 ORGNTR APLCTN TRANSC Originator Application Transaction Identifier Hierarchical TN ID Transaction BHT04 Beginning of STHDR 502 BHTO4 TS CREATN DT Transaction Set Creation
96. e Control Header ISA10 Interchange OEISA 501 ISA10 Interchange Time Control Header ISA11 Interchange OEISA 501 ISA11 REPTN SEPRTR Repetition Separator Control Header ISA12 Interchange OEISA 501 ISA12 VERSN NR Interchang Control Version Number Control Header ISA13 Interchange OEISA 501 ISA13 Interchange Control Number Control Header ISA14 Interchange 501 5 14 Acknowledgment Requested Control Header ISA15 Interchange OEISA 501 ISA15 USG IND Interchange Usage Indicator Control Header ISA16 Interchange OEISA 501 ISA16 SUBELE SEP Component Element Separator Control Header IEAO1 Interchange OEISA 503 1 GS Number of Included Functional Groups Control Trailer IEAO2 Interchange OEISA 503 2 ICN Interchange Control Number Control Trailer Loop GROUP HEADER GSHDR 6502 Functional Group GSHDR 501 GSO2 APP SENDR CD Application Senders Code Header 6503 Functional Group GSHDR 501 6503 APP RECVR CD Application Receivers Code Header 6504 Functional Group GSHDR_S 1_GS 4_DT Date Header GS 5 Functional Group GSHDR_S 1_GS 5_TM Time Header 6506 Functional Group GSHDR 501 6506 Group Control Number Header 6508 Functional Group GSHDR 501 GSO8 VERS ID CD Version Release Industry Identifier Code Header GEO1 Functional Group GSHDR 503 GEO1 TS Number of Transaction Sets Included Trailer GE 2 Functional Group GSHDR_S 3_GE 2_GCN Group Control Number Trailer Loop TRANSACTION SET
97. e Eligibility Benefit Inquiry Response 271 Addenda 1 Health Care Claim Status Request 276 Health Care Claim Status Response 277 Health Care Claim Status Response 277CA Health Care Services Review Request for Review 278 Health Care Services Review Response 278 Payroll Deducted and Other Group Premium Payment for Insurance Products 820 Addenda 1 Benefit Enrollment and Maintenance 834 Addenda 1 CHIAPAS EDI 2012 USER MANUAL Page 67 5010 835 BIN Health Care Claim Payment Advice 835 5010 837D BIN Health Care Claim Dental 837 5010 837D A1 BIN Addenda 1 5010 837D A2 BIN Addenda 2 5010 8371 BIN Health Care Claim Institutional 837 5010 837 1 Addenda 1 5010 837 A2 BIN Addenda 2 5010 837P BIN Health Care Claim Professional 837 5010 837P 1 Addenda 1 5010 999 A1 BIN Transaction Acknowledgment 999 Result The result of the query is stored in the supplied string variable CGateArg CGateArg A To CGateState ArgO1 To CGateState Arg02 To CGateState Arg03 To CGateState Arg04 This activity is used when the Workflow is ready to make the transition a scheduled or triggered process and propagates information sent to it by the Scheduler system Up to four string variables are supplied and these will be populated with the information specific for the type of trigger that fired this Workflow The information supplied depends on the trigger type a
98. e and add Flat HKey SegPool Lo 5 messages to the active Message Log that will be File 999 Ack 7 displayed in the SegPool pane 999 ACK to File Execute File to 999 ACK Parse 999 Generate 999 Generate 999 This will generate a basic 999 acknowledgment file indicating Accepted when a Decode event is able to parse a file or Rejected in the case of a serious integrity error ACK 999 File Execute This will save a 999 file that was previously generated via the Generate 999 function or it will load in 999 Transaction Acknowledgment file that was generated from a clearinghouse 999 File The file to be saved or loaded CHIAPAS EDI 2012 USER MANUAL Page 36 Log Register Tab Flat HKey SegPool Log This Data I O tab allows the internal Log register to De Tabie be exported to a database table or a CSV file This Log to DB Table Bewe register tracks all messages and errors that can occur during an encode or decode process including critical integrity errors or more minor syntax errors The database format follows that of Table the MSGLOG table included in the ChiapasData database that is part of the distribution If the table does not exist it will be created Note that unlike other Chiapas EDI registers this is output only and not a read register DB Type Data Source DB Table Log to DB Table The single option available for this read only register Exe
99. e dragged over the grey rectangles inside CGateContext activities cannot be nested you cannot place one CGateContext inside of another Furthermore all of the other defined Chiapas EDI activities must be placed within a CGateContext container placing one outside of a CGateContext will result in an error The CGateContext storages the State of the Chiapas engine and holds a single instance of all of the registers A single instance of the CGateContext activity can be used for a single Encode or Decode operation or a Decode operation and the creation of a 999 Acknowledgment file In order to carry out multiple operations within a single workflow multiple CGateContext activities must be used CHIAPAS EDI 2012 USER MANUAL Page 55 Upon first getting called it will automatically create and open a named database connection called TriggerDB to the chiapasData database that is part of the automation system the connection string is in a fixed location at C chiapas bin cnnstr txt If the automation system spawned this object it will pass the EVENT ID to the activity so that on completion it can pass all logged results back to the automation system It will also use this passed EVENT ID to pull the four possible string arguments from the automation system CGateTransfer Activity CGateTransfer Acton m D8 Type T Arg 01 Enter a VB expression Arg 02 Enter a VB expression This activity functions simil
100. e this example load in the include seed_834 txt sample file into the SegPool register press the Decode button and then select HKey to DB Tables fill in SQL Server as DB Type a valid Data Source and enter in PL as the prefix Then press Execute The resulting exported tables will appear like this PLISA Table T1 OEISA 501 ISA02 AUTH NFO OVL NO AUTH OEISA 501 5404 SEC NFO OVL PASSWD OEISA 501 ISA06 SENDR ID OVL MUTLY DEFND ID OEISA 501 ISA08 RECVR ID MUTLY DEFND ID OEISA 501 ISA09 DT OEISA 501 ISA10 TM OEISA 501 ISA11 REPTN SEPRTR OEISA 501 ISA12 VERSN NR OEISA 501 ISA13 ICN OEISA 501 ISA14 ACK REQ OEISA 501 ISA15 USG IND OEISA 501 ISA16 SUBELE SEP OEISA S03 IEAO1 GS CT OEISA S03 IEAO2 ICN KEY ID PAR KEY ID CHIAPAS EDI 2012 USER MANUAL Page 30 PLGSHDR Table GSHDR 501 502 APP SENDR CD GSHDR 501 6503 APP RECVR CD GSHDR 501 GS04 DT GSHDR 501 6505 GSHDR 501 6506 GCN GSHDR 501 6508 VERS ID CD GSHDR S03 6 01 TS CT GSHDR S03 6 02 GCN KEY ID PAR KEY ID PLSTHDR Table STHDR 501 5702 CONTRL NR STHDR 501 STO3 IMPLMNTN CONVNTN REFNC STHDR 502 BGNO1 TS PURPS CD STHDR S02 BGNO2 TS REF NR STHDR S02 BGNO3 TS CREATN DT STHDR 502 BGNO4 TS CREATN STHDR 502 BGNO8 ACTN CD STHDR S10 5 01 SEG CT STHDR S10 5 02 KEY ID PAR KEY ID CHIAPAS EDI 2012 USER MANUAL Page 31 In addition the tables PL1000A PL1000B PL2000 and PL2100A are all created and populated When we examine the 834
101. eQueryState This activity allows you to directly query the state of Chiapas Gate The value being queried is supplied in the incoming string and the result is assigned to the supplied string variable CHIAPAS EDI 2012 USER MANUAL Page 66 Arguments Query This is one of several values indicating the information being requested EVENT ID The Scheduler event ID that spawned this workflow SEGTERM The segment terminator of the current SegPool object ELETERM The element terminator of the current SegPool object SUBELETERM The element terminator of the current SegPool object SPEC SHRT NM Short name of the currently loaded specification SPEC LONG NM Long name of the currently loaded specification CRIT ERR this returns the value true if there was a critical integrity error encountered during decoding ERR CT returns the count of errors and messages in the Log register ERR LOG returns all messages in the log as a string FLAT COL CT returns the number of mappings within the Flat register FLAT ROW CT returns the number of rows within the Flat register LOCK COL CT returns the number of mappings within the Lock register SEG CT returns the number of segments within the SegPool object FLAT SPEC NM HKEY SPEC NM SEG SPEC NM Either one of these strings will cause the Chiapas Gate engine to interrogate the Flat HKey or SegPool registers for information about the associated specification
102. efix for the very first column in any CGIF table that defines the exact specification being used 4010 837P 1 5010 278 Request etc Here are four different examples that describe how Chiapas EDI 2012 associates a business element to a HIPAA element CHIAPAS EDI 2012 USER MANUAL Page 20 Scenario 1 Patient Account Number In this example we want to describe the first element within the Claim segment of the Claim Information loop within an 837 Institutional HIPAA transaction In this scenario the loop name is followed by an S and the index to the specified segment followed by the two to three digit segment code the element number and the name of the element 12300 501 CLMO1 ACCT NR Spelled out this describes a complete path to the element Loop 2300 Segment 01 segment Element 01 Patient Account Number Scenario 2 Claim Note Segment Iterations The twenty fourth segment in the 2300 loop is the Claim Note segment which can repeat up to ten times Furthermore Claim Notes are divided into a number of categories including Medications Diagnosis Description Durable Medical Equipment Supplies and so on In CGIF any information that is qualified by a value in a preceding element is called an overload and all overloads have their own discrete mapping These mappings would reference the first three occurrences of a Claim Note segment containing information on Durable Medical Equipment Supplies L2
103. el 2007 format HKey XML File HKey XML File Imports and exports the HKey register to an XML file HKey DB Tables HKey DB Tables Imports and exports the HKey register to a collection of database tables using an indicated prefix Every loop that encodes business information is used for export For importing Chiapas Gate checks all the loops possible for the specification indicated within the mandatory Specification Tag within the first mapping in the ISA loop SegPool File SegPool File Imports and exports the SegPool register to an ASC X12 file Note that the options set using the CGateSeg activity will need to be set prior to encoding CHIAPAS EDI 2012 USER MANUAL Page 57 SegPoolAck File SegPoolAck File Imports and exports the SegPoolAck register to a 999 Transaction Acknowledgment file The register is loaded first via a CGateAckGenerate activity The content of this file will depend on the results of a previous Decode operation Chiapas EDI 2012 will return success unless there was a critical parser stopping HIPAA integrity error CGateMsg Activity This activity is used to either clear or log messages and errors to the Log register Upon completion of the workflow these errors will automatically be logged to the automation system if the workflow was executed via a trigger Add Simple Message This action will add a simple message to the Log Add Full Message This action will add a complex mes
104. enerally used to transmit groups of information in batches However within healthcare enterprise systems healthcare data is rarely stored this way most often it lays embedded within relational databases where information is stored in columns and rows Transforming relational healthcare information like claims and member information into a hierarchical format like 5010 and vice versa is the primary focus of this software package The Chiapas Gate Intermediate Format or CGIF represents the syntax that Chiapas EDI uses to identify HIPAA elements and assign human understandable names to them Furthermore it uses a number of prefixes to fix the location of an element to a specific specification loop and segment When Chiapas EDI is decoding a hierarchical EDI message structure to a two dimensional format it assigns a new column to every unique data element encountered Every row represents a new iteration of what is called the deepest key meaning the deepest loop containing repeating information within the transaction For an 837 Professional or Institutional transaction the deepest key would CHIAPAS EDI 2012 USER MANUAL Page 18 be the Claims Detail loop where every row represents a new service line within a claim Within Chiapas EDI every loop defined within the HIPAA Implementation Guides that has 24 or more possible iterations is mapped vertically as new rows Loops containing 23 or less possible iterations are mapped horizontally a
105. er Information Loop SUBSCRIBER NAME 2010BA NM103 Subscriber Name NM104 Subscriber Name NM109 Subscriber Name N301 Subscriber Communication Number Telephone Receiver Name Non Person Entity Receiver Primary Identifier Electronic Transmitter Identification Number ETIN Hierarchical ID Number Billing Provider Last or Organizational Name Non Person Entity Billing Provider Address Line Billing Provider City Name Billing Provider State or Province Code Billing Provider Postal Zone or ZIP Code Billing Provider Tax Identification Number Employer s Identification Number Hierarchical ID Number Hierarchical Parent ID Number Hierarchical Child Code Payer Responsibility Sequence Number Code Individual Relationship Code Claim Filing Indicator Code Subscriber Last Name Person Subscriber First Name Subscriber Primary Identifier Member Identification Number Subscriber Address Line CHIAPAS EDI 2012 USER MANUAL Page 121 01 Subscriber City L2010BA 503 401 CITY NM Subscriber City Name State ZIP Code 02 Subscriber City L2010BA 503 402 STAT CD Subscriber State Code State ZIP Code Subscriber City L2010BA 503 N403 SUB POSTL ZON ZIP C Subscriber Postal Zone or ZIP Code State ZIP Code D DMG 2 Subscriber L2010BA 504 DMGO2 BIRTH DT OVL DT CC Subscriber Birth Date Date Expressed in Demographic YYMMDD F
106. erchange Control Number Header ISA14 Interchange Control 501 5 14 REQ Acknowledgment Requested Header ISA15 Interchange Control OEISA 501 ISA15 USG IND Interchange Usage Indicator Header ISA16 Interchange Control OEISA 501 ISA16 SUBELE SEP Component Element Separator Header IEAO2 Interchange Control OEISA 503 2 ICN Interchange Control Number Trailer Loop GROUP HEADER GSHDR 6502 Function Group GSHDR 501 GSO2 APP SENDR CD Application Senders Code Header GS03 Function Group GSHDR 501 6503 APP RECVR CD Application Receivers Code Header GS06 Function Group GSHDR 501 GS06 Group Control Number Header GS08 Function Group GSHDR 501 GSO8 VERS ID CD Version Release Industry Identifier Code Header GEO2 Functional Group GSHDR S03 GEO2 GCN Group Control Number Trailer Loop TRANSACTION SET STHDR HEADER CHIAPAS EDI 2012 USER MANUAL STO2 STO3 BHTe3 04 05 06 5 02 Loop 2000A HL 4 Loop 2100A NM103 NM109 Loop 2200A TRNe2 DTP03 DTPO3 Loop 2000B HLO4 Loop 2100B NM103 NM109 Loop 2200B TRN 2 01 01 01 02 STCO2 STCO3 5 04 0 02 Transaction Set Header Transaction Set Header Beginning of Hierarchical Transaction Beginning of Hierarchical Transaction Beginning of Hierarchical Transaction Beginning of Hierarchical Transaction Transaction Set Trailer INFORMATION SOURCE LEVEL Inform
107. erface dealing with CGIF mappings outlined in orange The specification Loop Loop Iteration Segment Segment Iteration Element Sub Element and Overload can all be individually selected Selecting each combo box will re populate the combo boxes below it in sequence which allows any of the more than 17 000 mappings to be selected and mapped At the bottom of the Data I O Interface is the Information Display which shows information Sesion DataUO Fist HKey Window Help EDI TECHNOLOGIES Inc Flat SegPoo Log File 999 Ack 9 SegPoo to File File to SegPool SegPool file eMapasinen output tet APP SENDR CD2SENDR ID GS02 APP SENDR CD APP RECVR CD RECVR ID GS03 APP RECVR CD 1j lt GS06_GCN gt _ID_CD gt 005010X222A1 lt G508_VERS_ID_CD gt 5702 CONTR NR 100000000 lt STO2_CONTRIL_NR gt 5703 IMPLMNTN GUID VERSN gt 005010 22241 lt 5 03 IMPLMNTN GUID VERSN NM CHIAPAS EDI 2012 USER MANUAL Page 26 about currently loaded registers It also has the Encode and Decode buttons Encode will translate the HKey register to the SegPool register and Decode will translate the SegPool register to the HKey register The green area is the Message Log which keeps a running log of Chiapas Studio operations Data I O Interface This part of Chiapas Studio is focused on the import and export of data in a variety of data formats The top row of tabs represent the Chiapas EDI registers
108. errors they will be logged A critical parsing error will stop decoding entirely and result in a critical error CHIAPAS EDI 2012 USER MANUAL Page 61 Data I O Activities CGateCNNAdd Activity This activity registers a named data source with the Chiapas Gate engine state object associated with the CGateContext activity Other CGate I O activities can refer to this connection by name alone Arguments CNNDataSource Connection string for the data source Like all Workflow strings they need to be encapsulated with quotes CNNDBType This string indicates the type of database connection It should be None Sql Server ODBC OleDB or SQLite Note that this string is case sensitive CNNName The name to associate with this connection CGateCNNOpen This will open the specified connection Arguments CNNName Name of the connection established with CGateCNNAdd CGateCNNClose This will close the specified connection Every database connection that is opened via Windows Workflow activities should also be closed CHIAPAS EDI 2012 USER MANUAL Page 62 Arguments CNNName Name of the connection CGateSQLExec This activity will execute a specified string on the indicated named connection Arguments CNNName Name of the connection CNNSQL SQL string to execute CGateSQLExecScript This activity will load the specified file as a text SQL script to be immediately executed on the named connection
109. ery business element is assigned to a unique name that fully qualifies both the data element and its position within the hierarchical EDI format This format is called the Chiapas Gate Intermediate Format or CGIF This is covered in the first chapter of the User Reference CGIF provides a layer of abstraction against the complexities of the 5010 format and is similar to working with a data dictionary associated with a database system In this case the CGIF data dictionary defines 23 730 unique data elements for the 4010 and 5010 CHIAPAS EDI 2012 USER MANUAL Page 16 specifications Once a business analyst becomes familiar with associating CGIF elements with the corresponding HIPAA elements the processes of decoding incoming EDI messages as well as creating them become much simpler Once the logistics of the actual decode or encode is worked out using the front end Chiapas Studio the developer can then use the library of included automation components to create completely automated hands free business processes Chiapas Studio is covered in the second chapter of the User Reference and the automation components are covered in the third chapter CHIAPAS EDI 2012 USER MANUAL Page 17 CHIAPAS GATE INTERMEDIATE FORMAT To understand how this naming convention functions it s first necessary to review the fundamental structure of any HIPAA transaction and how these structures are used in modern healthcare communications At the highest level of
110. execute the following query against the chiapasData database SELECT L2010BA 501 NM104 SUB FNAME L2010BA 501 NM103 SUB LNAME OVL PERSN FROM chiapasData dbo TUTORIAL 837P EXPORT WHERE 12400 S11 DTPO3 SVC DT OVL SVC D8 gt 20120120 The results of this query show the first and last names of subscribers linked to a date of service past January 20 2012 CHIAPAS EDI 2012 USER MANUAL Page 11 20 SU ENOME LN SOT NMUIS SUR LE OVi PERSH 1 LARRY SANDWICH 3 KIRK CHEESE 4 JOHN BURGER ENCODING This example will demonstrate how to use Chiapas EDI to progress from some simple mock healthcare information and transform it into a fully compliant EDI file Let s start with examining some of the mock healthcare information First let s investigate the Member table Using SQL Server Management Services SSMS connect to the chiapasData database and open a new query window Run the following query SELECT TOP 10 FROM MEMBER MEM ID FIRST NM LAST NM SSN ID BIRTH DT GENDER ADD ADD2 CITY STATE ZIP CD PHONE NR i 1 H 1 JOHN BURGER 987654320 19800707 M 123AST SANFRANCISCO 94117 4155551200 2 p STEVE FILET 987654321 19700404 M 222BST NULL SANFRANCISCO CA 94117 4155551201 3 LAWRENCE 987654322 19500404 M 987C ST NULL SANFRANCISCO CA 94117 4155551202 4 1 JAKE NOODLES 987654323 19600303 M 654057 NULL SANFRANCISCO CA 94117 4155551203 5 5 ABIGAIL STROGANOFF 987654324 19900808 F 123
111. f STHDR 502 BHTO3 SUBMTR TRANSCTN I Submitter Transaction Identifier Hierarchical D Transaction BHT04 Beginning of STHDR 502 BHTO4 TS CREATN DT Transaction Set Creation Date Hierarchical Transaction BHT 5 Beginning of STHDR_S 2_BHT 5_TS_CREATN_TIM Transaction Set Creation Time Hierarchical Transaction SEO1 Transaction Set STHDR 504 SEO1 SEG Transaction Segment Count Trailer 5 02 Transaction Set STHDR S04 5 2 Transaction Set Control Number Trailer Loop INFORMATION SOURCE 2000A LEVEL HLO1 Information Source L2000A 501 HLO1 HIERCHCL ID NR Hierarchical ID Number Level HLO4 Information Source L2 A_S 1_HL 4_HIERCHCL_CHILD_CD Hierarchical Child Code Level Loop INFORMATION SOURCE 2100A NAME NM103 Information Source L2100A PR 501 NM103 NFO SOURC LAS Information Source Last or Organization Name Name T ORG NM OVL NONPRSN ENTY Non Person Entity NM109 Information Source L2100A PR 501 NM109 NFO SOURC PRI Information Source Primary Identifier Name MRY ID OVL FED TAX ID NR Federal Taxpayer s Identification Number Loop INFORMATION RECEIVER 2000B LEVEL HLO1 Information Receiver L2000B 501 HLO1 HIERCHCL ID NR Hierarchical ID Number Level HLO2 Information Receiver L2000B 501 HLO2 HIERCHCL PARNT ID Hierarchical Parent ID Number Level _NR HLO4 Information Receiver L2000B 501 HLO4 HIERCHCL CHILD CD Hierarchical Child Code Level Loop INFORMATION RECEIVER 2100B NAME NM102 Information Receiver L2100B 1P 501 NM102 ENTY TYPE QUA Entity Type
112. formation Subscriber Information Subscriber Information SUBSCRIBER NAME Subscriber Name Subscriber Name Subscriber Name Subscriber Address Subscriber City State ZIP Code Subscriber City State ZIP Code Subscriber City State ZIP Code Subscriber Demographic Information Subscriber Demographic Information PAYER NAME Payer Name Payer Name Payer Address Payer City State ZIP Code Payer City State ZIP Code Payer City State ZIP Code CLAIM INFORMATION 12000 501 HLO4 HIERCHCL CHILD CD L2000B 502 SBRO1 PAYR RESP SEQNC NR CD L2000B 502 SBRO2 INDVDL REL CD L2000B 502 SBRO9 FILNG IND CD L2010BA 501 NM103 SUB LNAME OVL PERS N L2010BA 501 NM104 SUB FNAME L2010BA 501 NM109 PRIMRY ID OVL MEM ID NR L2010BA 502 N301 ADRS LIN L2010BA 503 01 CITY NM L2010BA 503 N402 STAT CD L2010BA 503 403 SUB POSTL ZON ZIP C D L2010BA 504 DMGO2 BIRTH DT OVL DT CC YYMMDD L2010BA 504 DMGO3 GENDR CD L2010BB SO1 NM103 PAYR NM OVL NONPRS N ENTY L2010BB 501 NM109 PAYR ID OVL PAYR I D L2010BB 502 N301 ADRS LIN L2010BB 503 01 CITY NM L2010BB 503 402 PAYR STAT PROVNC CD L2010BB 503 N403 PAYR POSTL 20 ZIP Claim Information Claim Information Claim Information Claim Information Claim Information Claim Information Claim Information Claim Information Claim Information Claim Information RENDERING PROVIDER NAME Page 127
113. ge OEISA 503 1 GS Number of Included Functional Groups Control Trailer IEAO2 Interchange OEISA 503 2 ICN Interchange Control Number Control Trailer Loop GROUP HEADER GSHDR 6502 Functional Group GSHDR 501 6502 APP SENDR CD Application Senders Code Header 6503 Functional Group GSHDR 501 6503 APP RECVR CD Application Receivers Code Header 6504 Functional Group GSHDR 501 6504 DT Date Header GS05 Functional Group GSHDR 501 6505 Time Header GS06 Functional Group GSHDR_S 1_GS 6_GCN Group Control Number Header 6508 Functional Group GSHDR 501 GSO8 VERS ID CD Version Release Industry Identifier Code Header GEO1 Functional Group GSHDR S03 GEO1 TS CT Number of Transaction Sets Included Trailer GEO2 Functional Group GSHDR S03 GEO2 GCN Group Control Number Trailer Loop TRANSACTION SET STHDR HEADER 5 02 Transaction Set STHDR 501 STO2 CONTRL NR Transaction Set Control Number Header BHTO1 Beginning of STHDR 502 BHTO1 STRUCTR CD Hierarchical Structure Code Hierarchical Transaction BHT 2 Beginning of STHDR 502 BHTO2 TS PURPS CD Transaction Set Purpose Code Hierarchical Transaction CHIAPAS EDI 2012 USER MANUAL BHTO3 BHTOA BHT 6 5 01 5 02 Loop 1000A NM103 NM109 PERO2 PERO4 Loop 1000B NM103 NM109 Loop 2000A HLO1 Loop 2010AA NM103 N301 4 1 N402 NA03 REF02 Loop 2000B HL0O1 02 Beginning of Hierarchical Transact
114. gger to certain days of the week Months This checkbox allows you to filter the trigger to operate only on specified calendar months CHIAPAS EDI 2012 USER MANUAL Page 53 Events History Tab This shows the trigger history Clicking on one will populate the log screen on the right which shows all of the messages generated from the Workflow during the execution of the event CHIAPAS EDI 2012 USER MANUAL Page 54 Workflow Activity Reference This is a reference of the Activities available within Chiapas EDI 2012 Some of them have a customized user interface where values can be plugged directly on the surface others do not and will need their values entered into the Properties window on the right of the main window One important note is that within Windows Workflow 4 expression text boxes need to be valid VB NET expressions which means all text strings need to be enclosed in quotes There are several excellent resources and books on Windows Workflow 4 these can help with getting the most out of this platform This section is meant to supplement that knowledge to learn how to use Windows Workflow 4 to use the Chiapas Gate technology CGate Core Activities CGateContext Activity Flowchart n a Double click to viev This activity is the main container for all other Chiapas EDI activities It is defined as a special Sequence activity to add more Activities inside they need to b
115. gister is to be loaded from CGateCNNFetchDT This activity will load a supplied datatable variable with the contents of a view or table on a specified named database connection Arguments CNNName Name of the database connection CNNTable Name of the table or view Result A supplied DataTable variable that will be written to CGateCNNPutDT This activity will push a supplied DataTable variable to a database table You may indicate whether to drop the receiving table first or not Arguments CNNName name of the connection DT a DataTable variable CNNTable name of the table to push the DataTable to Replace if this string value is to true the receiving database table will be recreated CGateDTToFlat This activity copies the contents of a DataTable to the Flat register CHIAPAS EDI 2012 USER MANUAL Page 65 Arguments DT a supplied DataTable variable CGateDTFromFlat This activity copies the contents of the Flat register to a supplied DataTable variable Arguments DT a supplied DataTable variable CGateHKeyToXML This activity will copy the HKey register to a supplied string variable as XML Arguments HKeyXML the string variable that will receive the HKey s XML text CGateHKeyFromXML This activity converts the supplied string variable to an XML document and loads the HKey register with it Arguments HKeyXML the string variable containing CGIF XML that will get loaded to the HKey register CGat
116. graphic Information Loop SUBSCRIBER 2110C ELIGIBILITY OR BENEFIT INQUIRY CHIAPAS EDI 2012 USER MANUAL Page 100 001 Subscriber Eligibility or Benefit Inquiry L2110C 501 EQO1 SVC TYPE CD Service Type Code Specification 5010 271 Reference Segment Mapping Loop ISA GROUP HEADERS ISAe2 Interchange Control N1_OEISA_S 1_ISA 2_AUTH_NFO_OVL_N Authorization Information No Authorization Header O AUTH NFO Information Present 5 04 Interchange Control OEISA 501 15404 SEC NO SE Security Information No Security Information Header C NFO Present 5 06 Interchange Control OEISA 501 5 06 SENDR ID OVL Interchange Sender ID Mutually Defined Header DEFND ID 5 08 Interchange Control OEISA 501 ISAO8 RECVR ID OVL Interchange Receiver ID Mutually Defined Header Y DEFND ID ISA 9 Interchange Control OEISA_S 1_ISA 9_DT Interchange Date Header ISA10 Interchange Control OEISA 501 ISA10 Interchange Time Header ISA11 Interchange Control OEISA 501 ISA11 REPTN SEPRTR Repetition Separator Header ISA12 Interchange Control OEISA 501 ISA12 VERSN NR Interchang Control Version Number Header ISA13 Interchange Control OEISA 501 ISA13 Interchange Control Number Header ISA14 Interchange Control OEISA 501 ISA14 REQ Acknowledgment Requested Header ISA15 Interchange
117. ice 501 12110 503 501 ADJ GRP CD Claim Adjustment Group Code Adjustment 502 Service 12110 503 CASO2 ADJ RSN CD Adjustment Reason Code Adjustment 503 12110 503 CASO3 ADJ AMT Adjustment Amount Adjustment AMTO2 Service 12110 508 2 SVC SUPP AMT OVL ALW Service Supplemental Amount Allowed Actual Supplemental D ACTL Amount 501 12110 503 501 IO2 ADJ CD Claim Adjustment Group Code Adjustment 502 Service 12110 503 502 102 ADJ RSN CD Adjustment Reason Code Adjustment 503 12110 503 CASO3 102 ADJ AMT Adjustment Amount Adjustment Specification 5010 837D Loop ISA GROUP HEADERS ISAe2 Interchange V2 OEISA 501 15 02 AUTH NFO OVL NO A Authorization Information No Authorization Control Header UTH NFO Information Present 5 04 Interchange OEISA 501 15404 SEC OVL NO SEC Security Information No Security Information Control Header FO Present 5 06 Interchange OEISA 501 5 06 SENDR ID OVL MUTLY D Interchange Sender ID Mutually Defined Control Header EFND ID 5 08 Interchange OEISA 501 ISAO8 RECVR ID OVL MUTLY D Interchange Receiver ID Mutually Defined Control Header EFND ID CHIAPAS EDI 2012 USER MANUAL Page 119 ISA09 Interchange OEISA 501 15409 DT Interchange Dat
118. ice Provider L2000C 501 HLO1 HIERCHCL ID NR Hierarchical ID Number Level 02 Service Provider L2000C SO1 HLO2 HIERCHCL PARNT ID Hierarchical Parent ID Number Level _NR Loop PROVIDER NAME 2100C NM102 Provider Name L2100C 501 102 TYPE QUAL Entity Type Qualifier NM103 Provider Name L2100C 501 NM103 PROV LAST ORG Provider Last or Organization Name NM109 Provider Name L2100C 501 NM109 PROV ID FED Provider Identifier Federal Taxpayer s TAX ID NR Identification Number Loop SUBSCRIBER LEVEL 2000D HLO1 Subscriber Level L2000D 501 HLO1 HIERCHCL ID NR Hierarchical ID Number HL 2 Subscriber Level L2 D_S 1_HL 2_HIERCHCL_PARNT_ID Hierarchical Parent ID Number _NR HLO4 Subscriber Level L2000D 501 HLO4 HIERCHCL CHILD CD Hierarchical Child Code DMG 2 Subscriber L2 D_S 2_DMG 2_BIRTH_DT_OVL_DT_ Subscriber Birth Date Date Expressed in Demographic CCYYMMDD Format CCYYMMDD Information DMG03 Subscriber L2000D 502 DMGO3 GENDR CD Subscriber Gender Code Demographic Information CHIAPAS EDI 2012 USER MANUAL Page 104 Loop SUBSCRIBER NAME 2100D NM103 Subscriber Name 121000 501 NM103 SUB LNAME OVL PE Subscriber Last Name Person RSN NM104 Subscriber Name 121000 501 NM104 SUB FNAME Subscriber First Name NM109 Subscriber Name L2100D 501 NM109 SUB ID OVL MEM I Subscriber Identifier Member Identification D NR Number Loop CLAIM STATUS 2200D TRACKING NUMBER TRN 2 Claim Statu
119. in the Encounter Data Activity Current Datestamp Current Timestamp Value set in the Encounter Data Activity Value set in the Encounter Data Activity ICN Value set in the Encounter Data Activity right padded with zeros 0 P Value set in the SegPool Value set according to specification Sender Code Value set in Encounter Data Activity CHIAPAS EDI 2012 USER MANUAL Page 60 GS03 Receiver Code Value set in Encounter Data Activity GS04 Current Datestamp GS05 Current Timestamp GS06 GCN Value set in the Encounter Data Activity 6507 X GS08 Value set according to specification STO2 TCN Value set in the Encounter Data Activity STO3 Value set according to specification BHT04 Current Datestamp BHTO5 Current Timestamp SEO1 Calculated Segment Count SEO2 TCN Value set in the Encounter Data Activity GEO1 Calculated Transaction Count GEO2 GCN Value set in the Encounter Data Activity IEAO1 Calculated Group Count IEA02 ICN Value set in the Encounter Data Activity HLO1 Indexed according to situation HLO2 Indexed according to situation HLO3 20 21 22 or 23 HLO4 Chiapas Gate will fill in for a 1 for when HLO3 20 and a 0 for when HLO3 23 User must supply 0 or 1 according to the presence of children HL loops 01 Incremented according to situation This activity depends on a loaded SegPool register and will try to decode it to the HKey register If the decoder encounters any SNIP Type 1 and SNIP Type 2 integrity
120. iodically polls the chiapasData database for active trigger conditions When a trigger condition is fulfilled a new Event is launched In the background a Worker process will take ownership of the new event load in the associated workflow execute it with the passed arguments passed to the workflow from the automation system and then exit The background service will refresh the worker process automatically This ensures that no single event can hang the whole automation system or consume all memory resources The criteria for launching new events include scheduled events events triggered by the results of a SQL query events triggered by files appearing in an upload directory events triggered by new files appearing in an archive directory files being uploaded to a CHIAPAS EDI 2012 USER MANUAL Page 45 remote SecureFTP server upload directory or new files being uploaded to a remote SecureFTP archive directory A single Chiapas EDI 2012 workflow is oriented to handling or creating a single discrete file Due to the memory intensive nature of the Encode Decode engines a single workflow should not be developed to process many files within a loop this leads to memory fragmentation and reliability issues and is not a supported development model Using the Workflow Studio im Workfiow Designer Host unsaved e x The workflow studio has functionality for creating and debugging workflows loading and saving workflows and
121. ion Beginning of Hierarchical Transaction Beginning of Hierarchical Transaction Beginning of Hierarchical Transaction Transaction Set Trailer Transaction Set Trailer SUBMITTER NAME Submitter Name Submitter Name Submitter EDI Contact Information Submitter EDI Contact Information RECEIVER NAME Receiver Name Receiver Name BILLING PROVIDER HIERARCHICAL LEVEL Billing Provider Hierarchical Level BILLING PROVIDER NAME Billing Provider Name Billing Provider Address Billing Provider City State ZIP Code Billing Provider City State ZIP Code Billing Provider City State ZIP Code Billing Provider Tax Identification SUBSCRIBER HEIRARCHICAL LEVEL Subscriber Hierarchical Level Subscriber Hierarchical Level STHDR S02 ORGNTR APLCTN TRANSC TN ID STHDR S02 BHTO4 TS CREATN DT STHDR 502 BHTO5 TS CREATN STHDR S02 BHTO6 ENCNTR ID STHDR 506 SEO1 SEG CT STHDR 506 5 02 11000 501 NM103 SUBMTR LAST ORG OVL_NONPRSN_ENTY L1000A 501 NM109 SUBMTR ID OVL ETN R L1000A 502 PERO2 CONTCT NM L1000A 502 PERO4 COMM NR OVL TELPHN 11000 501 NM103 RECVR NM OVL NONPRS N ENTY 11000 501 NM109 PRIMRY ID OVL ETN R L2000A 501 HLO1 HIERCHCL ID NR L2010AA 501 NM103 LAST ORGL NM OVL ONPRSN_ENTY L2010AA 502 N301 BILNG PROV ADRS LIN L2010AA 503 01 BILNG PROV CITY NM L2010AA 503 N402 STAT PROVNC CD L2010AA 503
122. ion Number Loop INFORMATION RECEIVER 2000B LEVEL HLO1 Information Receiver L2000B 501 HLO1 HIERCHCL ID NR Hierarchical ID Number Level HL 2 Information Receiver L2000B 501 HLO2 HIERCHCL PARNT ID Hierarchical Parent ID Number Level _NR Loop INFORMATION RECEIVER 2100B NAME NM103 Information Receiver L2100B 1P 501 NM103 NFO RECVR LAS Information Receiver Last or Organization Name Name T ORG NM OVL NONPRSN ENTY Non Person Entity NM109 Information Receiver L2100B 1 501 NM109 NFO RECVR ID Information Receiver Identification Number Name NR OVL FED TAX ID NR Federal Taxpayer s Identification Number Loop SUBSCRIBER LEVEL 2000C HLO1 Subscriber Level L2000C 501 HLO1 HIERCHCL ID NR Hierarchical ID Number 02 Subscriber Level L2000C 501 HLO2 HIERCHCL PARNT ID Hierarchical Parent ID Number NR HLO4 Subscriber Level L2000C 501 HLO4 HIERCHCL CHILD CD Hierarchical Child Code Loop SUBSCRIBER NAME 2100C NM102 Subscriber Name L2100C SO1 NM102 ENTY TYPE QUAL Entity Type Qualifier NM103 Subscriber Name L2100C 501 NM103 SUB LNAME Subscriber Last Name NM104 Subscriber Name L2100C 501 NM104 SUB FNAME Subscriber First Name NM109 Subscriber Name L2100C 501 NM109 PRIMRY ID OVL Subscriber Primary Identifier Member M ID NR Identification Number DMG 2 Subscriber L210 C_S 6_DMG 2_BIRTH_DT_OVL_DT_ Subscriber Birth Date Date Expressed in Demographic CCYYMMDD Format CCYYMMDD Information DMG03 Subscriber L2100C 506 DMGO3 GENDR CD Subscriber Gender Code Demo
123. is table stores trigger information and which triggers are active EVENTS This table stores every event triggered by the automation system MSGLOG All messages generated by the events are stored here Trigger Info Tab CHIAPAS EDI 2012 USER MANUAL Page 50 Parameters Name Name of the Trigger Enabled When this is checked the trigger is actively polled by the background service Poll Interval This is the number of seconds between polling Note for resource intensive operations like large trigger queries or Remote file checks this should not be set to a very low value A value of 600 ten minutes is usually sufficient for most business processes This value can be set to 30 for processes being developer to allow the user to quickly see the results Workflow File This is the name of the XAML Workflow Activity created within the Workflow Interface File triggered events will be able to supply information to the Workflow Activity through the use of the CGateArg activity Creating a new Trigger First press the New button then type in the Trigger Name Poll Interval and the XAML Workflow file to be run when the event is fired Do not click Enabled at this time Then press Save and this will commit the new trigger to the backend system Afterwards select the trigger click on the Enabled checkbox and re save the trigger This will enable the trigger and add it for polling by the background CGateServer service Polling Info
124. ister Tab The SegPool interface presents an interface for loading HIPAA transaction text files into the SegPool register or saving a loaded SegPool register to a text file By HIPAA rules these files may contain Carriage Return Line Feed information different segment CHIAPAS EDI 2012 USER MANUAL Page 34 element and composite element separators and Chiapas EDI also allows a file to be exported with 80 column fixed line format Finally exported files may be sanitized of Protected Healthcare Information using a simple algorithm File SegPool to File Exports a loaded SegPool Register to a file with the given separator Flat HKey SegPool Log File 999 Ack 4 characters formatting options SegPool to File Execute m File to SegPool 4 CR v LF sco Css File to SegPool Loads the SegPool register ee from a specified file and automatically fills in SegPool File j 4 the formatting options according to the file SegSep EleSep SubEleSep contents CR If checked the file will have a Carriage Return ASCII 13 at the end of each segment LF If checked the file will have a Line Feed ASCII 10 at the end of each segment 80 COL Setting this checkbox will set the CR LF line terminators at 80 character boundaries Scrub PHI Setting this option before exporting will scrub it of Protected Healthcare Information Dates Names and Identifiers will be altered from the origi
125. its out of the application Data I O Flat HKey These menu options provide an alternate path to access commonly used Data I O functions The Flat menu offers one item not available on the rest of the interface Flat Maps Clipboard If there is a loaded Flat register this will create a four column description of the mappings contained within that register and paste it to the clipboard The Seed specifications at the end of this manual were created with the help of this function CHIAPAS EDI 2012 USER MANUAL Page 41 Window Studio Interface Workflow Interface Scheduler Interface This menu option is available throughout each of the three Chiapas EDI 2012 user interfaces and allows you to freely switch between them The current interface is marked with a checkmark Note that work is not preserved when switching interfaces WinSCP Sessions This launches the WinSCP Secure FTP client that comes bundled with Chiapas EDI 2012 The Chiapas Gate Workflow activities as well as the Scheduler system both communicate with this bundled client for remote Secure FTP operations Note that when configuring WinSCP Sessions the password needs to be saved Sessions should be tested and the network key cached before the session name is referenced by Chiapas EDI 2012 components Help Help System Brings up the integrated help system Set HIG Bindings CHIAPAS EDI 2012 USER MANUAL Page 42 1 REC RESP pat x 10 2
126. lOCopyFile This will copy a specified file Arguments CopyFrom Full path and name of the source file CopyTo Full path and name of the destination file CGatelODeleteFile Deletes a specified file Arguments DeleteFile Full path and name of the file to be deleted CGatelODirectory This will create a list of files found in the specified directory and then place them in the variable given the ResultFiles argument The variable must be of type string Arguments CHIAPAS EDI 2012 USER MANUAL Page 72 DirectoryPath Full path to the directory to be scanned ResultFiles The variable the results will be recorded to CGateRunShell Activity This command will execute an arbitrary shell command and wait for its completion If the command returns a non zero return value a message is added to the message log indicating the exit code Arguments ShellCmd A string that represents the full path and filename of the shell command to execute ShellArgs A string storing the command line arguments if any CHIAPAS EDI 2012 USER MANUAL Page 73 Message Reference Anytime an error occurs during an automation activity it will be logged to the distribution database During decoding operations the segment or element reference number may be included with the error The schema of the error log is covered in the Technical Reference chapter X12Decoder ConsumeSegment Data present on an element marked as Unused Element x
127. la s esp pH AME MERE 92 Seed Specification Definitions seen 98 Specification 98 CHIAPAS EDI 2012 USER MANUAL Specification Specification Specification Specification Specification Specification Specification Specification Specification Specification Specification Specification VNPT 100 5010 ET M 102 BO T lise E ed tite Saltese soe La tbo d indt 104 SOLO m X 106 108 50107278 RESP aceti dbi eti n 110 5010 02 0 ti iS ae ai 113 SOTO GIAE 114 5010 835 niaidne 116 SOTU OO D ade rendo ata tin 118 BO ELS T 121 BOT OS nc etie 125 CHIAPAS EDI 2012 USER MANUAL Page 4 INTRODUCTION Chiapas EDI 2012 was designed from the ground up to integrate HIPAA transactions with enterprise business processes as simply as possible The 4010 and 5010 HIPAA transactions are highly complex with hierarchical file formats that are anything but intuitive Embedded within this file format is the actual business data that trading partners need to exchange for ongoing business claims eligibility remittances and so on The core technology of Chiapas E
128. lectronic Transmitter Identification Number ETIN Loop SERVICE PROVIDER 2000C LEVEL HLO1 Service Provider L2000C 501 HLO1 HIERCHCL ID NR Hierarchical ID Number Level HLe2 Service Provider L2000C 501 HLO2 HIERCHCL PARNT ID Hierarchical Parent ID Number Level _NR HLO4 Service Provider L2000C 501 HLO4 HIERCHCL CHILD CD Hierarchical Child Code Level Loop PROVIDER NAME 2100C NM102 Provider Name L2100C 501 NM102 TYPE QUAL Entity Type Qualifier NM103 Provider Name L2100C SO1 NM103 PROV LAST ORG NM Provider Last or Organization Name NM109 Provider Name L2100C 501 NM109 PROV ID FED Provider Identifier Federal Taxpayer s TAX ID NR Identification Number Loop SUBSCRIBER LEVEL 2000D HLO1 Subscriber Level L2000D 501 HLO1 HIERCHCL ID NR Hierarchical ID Number CHIAPAS EDI 2012 USER MANUAL Page 106 HL 2 Subscriber Level L2 D_S 1_HL 2_HIERCHCL_PARNT_ID Hierarchical Parent ID Number _NR HLO4 Subscriber Level L2000D 501 HLO4 HIERCHCL CHILD CD Hierarchical Child Code Loop SUBSCRIBER NAME 2100D NM103 Subscriber Name 121000 501 NM103 SUB LNAME OVL PE Subscriber Last Name Person RSN NM104 Subscriber Name L2100D SO1 NM104 SUB FNAME Subscriber First Name NM109 Subscriber Name L2100D 501 NM109 SUB ID OVL MEM I Subscriber Identifier Member Identification D NR Number Loop CLAIM STATUS TRACKING 2200D NUMBER TRN 2 Claim Status Tracking L2200D 501 TRNO2 REFNCD TRANSCTN _ Refere
129. nals Note that this is merely a best guess to filter out the most commonly known pieces of publically identifiable information the only way to guarantee a file contains no PHI is to scrub all identifiers manually SegPool File Filename of the HIPAA text file to be created or loaded SegSep A single character representing the Segment Separator that marks the boundary between segments EleSep A single character representing the Element Separator that marks the boundary between elements CHIAPAS EDI 2012 USER MANUAL Page 35 SubEleSep A single character representing the composite element separator that marks the boundary between composite elements Not every transaction contains composite elements 999 Ack Chiapas EDI 2012 has limited built in support for 999 transactions A 999 transaction is generally a tool of clearinghouses to generate automated notifications notify of file rejection or integrity errors Chiapas EDI 2012 can generate a 999 after a Decode event either a simple 999 Acceptance record will be created if the file parsed without major errors or it will be Rejected for a serious integrity violation For incoming 999 messages Chiapas EDI 2012 can apply the 999 against an existing loaded SegPool and generate messages that can be displayed alongside the segments in the SegPool display allowing you to see which segments triggered the warnings that were listed within the 999 Parse 999 This will load a 999 fil
130. nced Transaction Trace Number Number TRAC NR 01 01 Claim Status Tracking 122000 502 STCO1 01 HLTHCR ST Health Care Claim Status Category Code Number 5 CATGRY CD TRNO1 02 Claim Status Tracking L2200D 502 STCO1 02 STATS CD Status Code Number STCe2 Claim Level Status 122000 502 STCO2 STATS NFO EFF DT Status Information Effective Date Information REF 2 Payer Claim Control L220 D_S 3_REF 2_PAYR_CLM_CONTRL_ Payer Claim Control Number Payor s Claim Number NR_OVL_PAYR_CLM_NR Number DTP03 Claim Service Date 122000 509 DTPO3 SVC PERD OVL SVC Claim Service Period Service RD8 RD8 Specification 5010 277CA Loop ISA ISA ISAe2 Interchange Control P5 OEISA 501 ISAO2 AUTH OVL N Authorization Information No Authorization Header O AUTH NFO Information Present 5 04 Interchange Control OEISA 501 15404 SEC NFO NO SE Security Information No Security Information Header C NFO Present 5 06 Interchange Control OEISA 501 5 06 SENDR ID OVL MUTL Interchange Sender ID Mutually Defined Header DEFND ID 5 08 Interchange Control OEISA 501 ISAO8 RECVR ID OVL MUTL Interchange Receiver ID Mutually Defined Header Y DEFND ID ISA11 Interchange Control OEISA 501 ISA11 REPTN SEPRTR Repetition Separator Header ISA12 Interchange Control OEISA 501 ISA12 VERSN NR Interchang Control Version Number Header ISA13 Interchange Control OEISA 501 ISA13 Int
131. ncipal Diagnosis Diagnosis Code International Classification of Diseases Clinical Modification ICD 9 CM Diagnosis CHIAPAS EDI 2012 USER MANUAL Page 128 NM103 Rendering L2310B 501 NM103 LAST ORG NM OVL NON Rendering Provider Last or Organization Name Provider Name PRSN ENTY Non Person Entity REF02 Rendering L2310B S03 2 RENDRNG PROV 2ND ID Rendering Provider Secondary Identifier Provider OVL PROV COMRCL NR Provider Commercial Number Secondary Identification Loop SERVICE LINE 2400 NUMBER LXe1 Service Line 12400 501 1 ASGND NR Assigned Number Number LX01 02 Service Line 12400 502 SV101 02 PROC CD OVL HCPCS Procedure Code Health Care Financing Number _ Administration Procedural Coding System HCPCS Codes Sv102 Professional 12400 502 SV102 LIN ITM CHG AMT Line Item Charge Amount Service SV104 Professional 12400 502 SV104 SVC UNT CT OVL UNT Service Unit Count Unit Service SV107 01 Professional 12400 502 SV107 01 DIAG CD POINTR Diagnosis Code Pointer Service DTP03 Date Service 12400 511 DTPO3 SVC DT OVL SVC D8 Service Date Service D8 Date
132. nt Requested Header ISA15 Interchange Control OEISA 501 ISA15 USG IND Interchange Usage Indicator Header ISA16 Interchange Control OEISA 501 ISA16 SUBELE SEP Component Element Separator Header IEAO1 Interchange Control OEISA 503 IEAO1 GS Number of Included Functional Groups Trailer IEAO2 Interchange Control OEISA 503 2 ICN Interchange Control Number Trailer Loop GROUP HEADER GSHDR 6502 Functional Group GSHDR 501 GSO2 APP SENDR CD Application Senders Code Header GS03 Functional Group GSHDR 501 6503 APP RECVR CD Application Receivers Code Header 6504 Functional Group GSHDR 501 6504 DT Date Header GS05 Functional Group GSHDR 501 GSO5 Time Header 6506 Functional Group GSHDR 501 6506 Group Control Number Header GEO1 Functional Group GSHDR S03 GEO1 TS CT Number of Transaction Sets Included Trailer GE 2 Functional Group GSHDR_S 3_GE 2_GCN Group Control Number Trailer CHIAPAS EDI 2012 USER MANUAL Page 105 Loop TRANSACTION SET STHDR HEADER 5 02 Transaction Set STHDR 501 STO2 CONTRL NR Transaction Set Control Number Header STe3 Transaction Set STHDR 501 STO3 VERS RELS INDSTRY Version Release or Industry Identifier Header ID 01 Beginning of STHDR S02 BHTO1 STRUCTR CD Hierarchical Structure Code Hierarchical Transaction BHT 3 Beginning of STHDR 502 BHTO3 ORGNTR APLCTN TRA Originator Ap
133. on database and selected Create To we will see the source code of the view vw Export 270 This view is an extract that translates from a sample set of eligibility and provider data to the format needed by Chiapas EDI 2012 to create a HIPAA compliant 5010 270 eligibility inquiry file This represents a seed extract that can help trading partners while setting up new HIPAA transactions i CREATE VIEW dbo vw Export 270 CHIAPAS EDI 2012 USER MANUAL Page 92 The view is responsible for the transformation of the raw mock table data used for this extract to a form Chiapas EDI can encode into HIPAA elements The full list of possible mappings is located on C chiapas docs CGIF For this extract all of the possible CGIF mappings for the 270 specification is located in the file 5010 270 html Modifiers for the Addenda 1 specification are listed in 5010 270 A1 html and is viewable with any web browser Decoder Tutorial In this section we ll investigate decoding arbitrary files placed into a directory and have them logged and storaged in one of four different tables Again we ll start in the Scheduler interface and create a new trigger 1 Launch C chiapas bin ChiapasStudio exe 2 At the top of the screen pull down the Window menu option and select Scheduler Interface Switch to the All Triggers pane Press the New button Press OK Select the new trigger that was generated mi
134. ontrol Version Number Control Header ISA13 Interchange OEISA 501 ISA13 Interchange Control Number Control Header ISA14 Interchange OEISA 501 ISA14 REQ Acknowledgment Requested Control Header ISA15 Interchange OEISA 501 ISA15 USG IND Interchange Usage Indicator Control Header ISA16 Interchange OEISA 501 ISA16 SUBELE SEP Component Element Separator Control Header IEAO1 Interchange OEISA 503 1 GS Number of Included Functional Groups Control Trailer IEAO2 Interchange OEISA 503 2 ICN Interchange Control Number Control Trailer Loop GROUP HEADER GSHDR 6502 Functional Group GSHDR 501 6502 APP SENDR CD Application Senders Code Header GS03 Functional Group GSHDR 501 6503 APP RECVR CD Application Receivers Code Header GSe4 Functional Group GSHDR_S 1_GS 4_DT Date Header GS 5 Functional Group GSHDR_S 1_GS 5_TM Time Header 6506 Functional Group GSHDR 501 6506 Group Control Number Header CHIAPAS EDI 2012 USER MANUAL Page 117 6508 Functional Group GSHDR 501 GSO8 VERS ID CD Version Release Industry Identifier Code Header GEO1 Functional Group GSHDR S03 GEO1 TS Number of Transaction Sets Included Trailer GE 2 Functional Group GSHDR_S 3_GE 2_GCN Group Control Number Trailer Loop TRANSACTION SET STHDR HEADER STO2 Transaction Set STHDR 501 STO2 CONTRL NR Transaction Set Control Number Header
135. op menu options and select Workflow Interface Create a new workspace Select File from the menu options and then select New Workflow Add a CGateTransfer activity Click on the CGateTransfer activity listed under the CGateCore category in the toolbox on the left then hold and drag the cursor to the grey bar at the top of the CGateContext activity in the center of the screen Release the mouse button This will result in adding the CGateTransfer activity to the workflow CHIAPAS EDI 2012 USER MANUAL Page 47 22 CGateContext 7 CGateTransfer A Action DEType Arg 01 Enter a VB expression Arg 02 Enter a VB expre 2 Set the options on the CGateTransfer activity Some Chiapas EDI 2012 workflows designers which are dynamic interfaces to the options within the activity In this case when the SegPool File action is selected unused options will disappear Action SegPool File File Path C NchiapasNsampleNseed 834 txt Add the CGateXlItDecode activity This is also found within the CGateCore category of the toolbox drag to to the gray bar beneath the CGateTransfer activity Add the CGateHKeyToFlat activity Again drag this to below the CGateXltDecode activity Add another CGateTransfer activity Set the options on the second CGateTransfer activity Action Flat CSV File File Path C NchiapasN834 out csv Run the workflow Under the Debug menu at the top of the s
136. organization all HIPAA transactions are grouped by specifications These specifications are defined in the HIPAA Implementation Guides are sold and published by the Washington Publishing Corporation WPC on behalf of the ASC X12 organization and are divided into two categories 4010 and 5010 Each of these categories defines a broad spectrum of healthcare communication specifications such as claims authorizations enrollments and remittance advice The 4010 set of specifications were finalized in 2002 whereas the 5010 specifications were finalized in 2008 Many of the transactions have one or two formally published Addenda that materially impact the specification Within each specification information is grouped into hierarchical structures called loops Loops are composed of segments which are themselves made of elements In certain cases elements are further divided into composite elements At every level numeric and alphabetical text qualifiers are used to identify the information being described within the loops and segments The specifications define every element possible with a given transaction but trading partners generally need to exchange only a small fraction of these elements to meet their business requirements Often at least one partner will formalize the required mappings into a Companion Guide which serves as an easy point of reference about what information is being exchanged Hierarchical protocols like XML and HIPAA are g
137. ormat CCYYMMDD Information DMG03 Subscriber L2010BA 504 DMGO3 GENDR CD Subscriber Gender Code Demographic Information Loop PAYER NAME 2010BB NM103 Payer Name L2010BB 501 NM103 PAYR NM OVL NONPRS Payer Name Non Person Entity N ENTY NM109 Payer Name L2010BB 501 NM109 PAYR ID PAYR I Payer Identifier Payor Identification D Loop CLAIM INFORMATION 2300 CLMO1 Claim Information 12300 501 CLMO1 PATNT CONTRL NR Patient Control Number CLMO2 Claim Information 12300 501 CLMO2 TOTL CHG AMT Total Claim Charge Amount CLM05 01 Claim Information 12300 501 5 01 PLAC SVC CD Place of Service Code CLM05 03 Claim Information 12300 501 5 03 FREQNCY CD OV Claim Frequency Code Place of Service Codes L PLAC SVC CODS PROF DENTL for Professional or Dental CLM 6 Claim Information 12300 501 CLMO6 PROV SUPLR SIGNTR IN Provider or Supplier Signature Indicator D CLM 7 Claim Information 12300 501 7 ASGNMNT PLAN PARTCPT Assignment or Plan Participation Code N CD CLMO8 Claim Information 12300 501 8 BENFTS ASGNMNT CERT _ Benefits Assignment Certification Indicator IND CLM 9 Claim Information 12300 501 09 RELS NFO CD Release of Information Code DTP03 Date Service 12300 504 DTPO3 SVC DT OVL SVC RD8 Service Date Service RD8 Date Loop SERVICE LINE 2400 NUMBER LX 1 Service Line L240 _S 1_LX 1_ASGND_NR Assigned Number Number LX01 02 Service Line 12400 502 SV301 02 PROC CD OVL AMRCN Procedure Code American Dental
138. pas EDI 2012 can transform into HIPAA files When decoding incoming EDI files the data can be put into a database form and queried very quickly In this way the business logic is isolated from the actual creation or decoding of a raw EDI file CHIAPAS EDI 2012 USER MANUAL Page 25 CHIAPAS STUDIO OVERVIEW The purpose of Chiapas Studio is to provide a workspace for building a data flow from the desired source to destination It s typically used in two ways The first way is as a tool to quickly check the syntax and data integrity of production EDI files that have some anomaly The second way is as a development tool to develop the mappings and ETL logic With both Chiapas Studio and SQL Server Management Studio SSMS open a developer can develop interfaces between enterprise systems and EDI files The screen is split into a number of different functional areas The Data I O Interface outlined in pink gives methods for loading and saving business data The Registers Interface outlined in purple represents the two main registers within Chiapas Gate the Flat and HKey registers The SegPool Interface on the right outlined in cyan represents the SegPool object In its default state it will also display any integrity messages associated with those segments The messages and segments can be viewed separately in different tabs A log of the users actions is kept in the upper right outlined in cyan and to the left of that is the Mapping Int
139. plication Transaction Identifier Hierarchical NSCTN ID Transaction BHT04 Beginning of STHDR 502 BHTO4 TS CREATN DT Transaction Set Creation Date Hierarchical Transaction BHT 5 Beginning of STHDR 502 BHTO5 TS CREATN Transaction Set Creation Time Hierarchical Transaction SEQ1 Transaction Set STHDR 504 SEO1 SEG CT Transaction Segment Count Trailer 5 02 Transaction Set STHDR 504 SEO2 Transaction Set Control Number Trailer Loop INFORMATION SOURCE 2000A LEVEL HLO1 Information Source L2000A 501 HLO1 HIERCHCL ID NR Hierarchical ID Number Level Loop PAYER NAME 2100A NM103 Payer Name L2100A SO1 NM103 PAYR NM OVL NONP Payer Name Non Person Entity RSN ENTY NM109 Payer Name L2100A 501 109 PAYR ID OVL PAYR Payer Identifier Payor Identification ID Loop INFORMATION RECEIVER 2000B LEVEL HLO1 Information Receiver L2000B 501 HLO1 HIERCHCL ID NR Hierarchical ID Number Level HLO2 Information Receiver L2000B 501 HLO2 HIERCHCL PARNT ID Hierarchical Parent ID Number Level _NR 04 Information Receiver L2000B 501 HLO4 HIERCHCL CHILD CD Hierarchical Child Code Level Loop INFORMATION RECEIVER 2100B NAME NM102 Information Receiver L2100B 501 102 TYPE QUAL Entity Type Qualifier Name NM103 Information Receiver L2100B 501 NM103 NFO RECVR LAST 0 Information Receiver Last or Organization Name Name RG NM NM109 Information Receiver L2100B 501 NM109 RECVR ID NR Information Receiver Identification Number Name OVL ETN NR E
140. r Residence L2100A IL 503 N301 ADRS LIN Member Address Line Street Address N401 Member City L2100A IL 504 401 CITY NM Member City Name State ZIP Code 02 Member City L2100A IL 504 402 STAT CD Member State Code State ZIP Code N4903 Member City L2100A_IL_S04_N403_MEM_POSTL_ZON_ZIP Member Postal Zone or Zip Code State ZIP Code _CD DMGO2 Member L2100A IL 505 DMGO2 BIRTH DT OVL DT Member Birth Date Date Expressed in Format Demographics CCYYMMDD CCYYMMDD DMG 3 Member L210 A_IL_S 5_DMG 3_GENDR_CD Gender Code Demographics Specification 5010_835 Loop ISA GROUP HEADERS ISAe2 Interchange U1 OEISA 501 15402 AUTH NFO OVL NO A Authorization Information No Authorization Control Header UTH NFO Information Present 5 04 Interchange OEISA 501 15404 SEC OVL NO SEC Security Information No Security Information Control Header FO Present 5 06 Interchange OEISA 501 5 06 SENDR ID OVL MUTLY D Interchange Sender ID Mutually Defined Control Header EFND ID ISA 8 Interchange OEISA_S 1_ISA 8_RECVR_ID_OVL_MUTLY_D Interchange Receiver ID Mutually Defined Control Header EFND_ID ISA09 Interchange OEISA 501 15409 DT Interchange Date Control Header ISA10 Interchange OEISA 501 ISA10 Interchange Time Control Header ISA11 Interchange OEISA 501 ISA11 REPTN SEPRTR Repetition Separator Control Header ISA12 Interchange OEISA 501 ISA12 VERSN NR Interchang C
141. ransmitter ETN NR Identification Number ETIN Loop SUBSCRIBER LEVEL 2000C HLO1 Subscriber Level L2000C 501 HLO1 HIERCHCL ID NR Hierarchical ID Number HL 2 Subscriber Level 12000 501 02 Hierarchical Parent ID Number NR Loop SUBSCRIBER NAME 2010C NM103 Subscriber Name L2010C 501 NM103 SUB LNAME Subscriber Last Name NM104 Subscriber Name L2010C 501 104 SUB Subscriber First Name NM109 Subscriber Name L2010C 501 109 PRIMRY ID OVL ME Subscriber Primary Identifier Member M ID NR Identification Number Loop PATIENT EVENT LEVEL 2000 HL 1 Patient Event Level L2000E SO1 HLO1 HIERCHCL ID NR Hierarchical ID Number 02 Patient Event Level L2000E SO1 HLO2 HIERCHCL PARNT ID Hierarchical Parent ID Number NR HLO4 Patient Event Level L2000E 501 HLO4 HIERCHCL CHILD CD Hierarchical Child Code UMO1 Health Care Services L2000E S03 UMO1 REQST CATGRY CD Request Category Code Review Information CHIAPAS EDI 2012 USER MANUAL Page 110 UMe2 Health Care Services L2000E 503 UMO2 CERT TYPE CD Certification Type Code Review Information 0 04 01 Health Care Services L2000E 503 0 4 01 FACLTY TYPE CD Facility Type Code Review Information 0 04 02 Health Care Services L2000E 503 0 04 02 FACLTY CD QUAL Facility Code Qualifier Review Information UMe9 Health Care Services L2000E 503 0 09 RELS NFO CD Release of Information Code Review Information DTP03 Admission Date L2000E
142. rchange Control OEISA 501 ISA09 DT Interchange Date Header ISA10 Interchange Control OEISA 501 ISA10 Interchange Time Header ISA11 Interchange Control OEISA SO1 ISA11 REPTN SEPRTR Repetition Separator Header ISA12 Interchange Control OEISA 501 ISA12 VERSN NR Interchang Control Version Number Header ISA13 Interchange Control OEISA 501 ISA13 Interchange Control Number Header ISA14 Interchange Control 501 5 14 Acknowledgment Requested Header ISA15 Interchange Control OEISA 501 ISA15 USG IND Interchange Usage Indicator Header ISA16 Interchange Control OEISA 501 ISA16 SUBELE SEP Component Element Separator Header IEAO1 Interchange Control OEISA 503 1 GS CT Number of Included Functional Groups Trailer IEAO2 Interchange Control OEISA 503 2 ICN Interchange Control Number Trailer Loop GROUP HEADER GSHDR 6502 Functional Group GSHDR 501 GSO2 APP SENDR CD Application Senders Code Header 6503 Functional Group GSHDR 501 6503 APP RECVR CD Application Receivers Code Header 6504 Functional Group GSHDR 501 6504 DT Date Header GS05 Functional Group GSHDR 501 GSO5 TM Time Header GS06 Functional Group GSHDR 501 6506 Group Control Number Header 6508 Functional Group GSHDR 501 GSO8 VERS ID CD Version Release Industry Identifier Code Header GEO1 Functional Group GSHDR S03 GEO1 TS Number of Transaction Sets Included Trailer GE 2 Functional Group GSHDR S03 GEO2 GCN Group Control
143. ring filename CGateTransfer This loads the passed filename into the SegPool register CGatexltDecode Decodes the SegPool register to the HKey register CGateQueryState This will query the Chiapas EDI engine as to the currently decoded specification and assign it to the strType string variable CGateCNNSOLGetScalar This executes SQL stored procedure on the chiapasData database The return value passed from the stored procedure is assigned to a variable The stored procedure is passed the specification name as an argument USP TEMP TABLE strType CHIAPAS EDI 2012 USER MANUAL Page 95 When we look at the source code behind the USP TEMP TABLE stored procedure we see the following Create a zero row temp table patterned off an existing bin table that will receive a Chiapas Merge operation CREATE PROCEDURE dbo USP TEMP TABLE TYPE VARCHAR 20 AS BEGIN declare random int upper int lower int rndtb varchar 20 4501 VARCHAR 1000 set lower 1 set upper 999999 select random ROUND upper lower rand lower 0 select rndtb temp tsubstring cast random as varchar 20 000000 1 6 SET TYPE REPLACE TYPE BIN SET SQL CASE WHEN TYPE IN 5010 834 5010 834 A1 THEN SELECT TOP 0 INTO rndtb FROM BIN 834 5 WHEN GTYPE 501
144. s For existing mappings selected in the Flat or Lock panes it displays verbose information about all the components of that mapping Otherwise it presents a straightforward interface for entering in new mappings When entering new mappings it s important to follow this sequence Loop Segment Element and Sub Element The selection of one combo box dynamically changes the contents in the next combo box in sequence so this order is important When enough selections are made to generate a valid mapping the CGIF name is populated in the CGIF Reference textbox Segpool Interface SegPool Msgs SegPoo Msgs The SegPool Display is responsible for displaying both the segments within the SegPool object as well as the Message object Normally messages are associated with specific segments so the default 000001 ISA 00 XYZP000000 00 0000000000 zz 000002 GS HP XYZP LMNO 20050315 1156 10201 000003 ST 835 102015216 000004 BPR Ii 0 00 C CHRK 4 9 2005031 000005 TRN 1 1 1900000000 000006 N1 PR XYZP 000007 N3 123 HOWARD ST STH FLOOR 000008 N4 SAN FRANCISCO CA 94105 000009 N1 PE CHN FI 900000001 000010 N3 LMNO ADD 1 000011 N4 SAN FRANCISCO CA 94105 000012 LX 1 000013 CLD I5925122A1 148534 02 0 HM 34787 000014 NMl OC ERICHARD 000015 NM1 82 1 UNKNWN PROV LAST NAME 000016 REF 1W 1001234567 000017 DTM 050 20041006 000018 SVC HC2L3000 0 238 36 2 000019 DTM 150 20040830 000020 DTM 151 200408
145. s L22 D_S 1_TRN 2_CURNT_TRANSCTN_T Current Transaction Trace Number Tracking Number RAC_NR REFO2 Payer Claim Control 122000 502 REFO2 PAYR CONTRL Payer Claim Control Number Payor s Claim Number NR OVL PAYR NR Number DTP03 Claim Service Date L2200D S10 DTPO3 SVC OVL SVC Claim Service Period Service RD8 RD8 Specification 5010 277 Loop ISA GROUP HEADERS ISAe2 Interchange Control PO OEISA 501 15402 AUTH NFO OVL N Authorization Information No Authorization Header O AUTH NFO Information Present 5 04 Interchange Control OEISA 501 15404 SEC NFO OVL NO SE Security Information No Security Information Header C NFO Present 5 06 Interchange Control OEISA 501 5 06 SENDR ID Interchange Sender ID Mutually Defined Header DEFND ID ISA 8 Interchange Control OEISA_S 1_ISA 8_RECVR_ID_OVL_MUTL Interchange Receiver ID Mutually Defined Header Y_DEFND_ID ISA 9 Interchange Control OEISA_S 1_ISA 9_DT Interchange Date Header ISA10 Interchange Control OEISA 501 ISA10 Interchange Time Header ISA11 Interchange Control OEISA 501 ISA11 REPTN SEPRTR Repetition Separator Header ISA12 Interchange Control OEISA 501 ISA12 VERSN NR Interchang Control Version Number Header ISA13 Interchange Control OEISA 501 ISA13 Interchange Control Number Header ISA14 Interchange Control OEISA 501 ISA14 REQ Acknowledgme
146. s a SQL View on the destination database that links all of the loaded HKey loop tables together to project a view of the table that can be loaded back into Chiapas EDI via the Flat key interface This view could also be used by a developer as a guide to reformat various internal data sources needed for different loops to present a correct CGIF representation back to Chiapas EDI XML This interface gives an XML transport for the HKey register By default whenever the HKey register is loaded an XML view is presented in the user interface An example of an iteration of an 5010 834 eligibility loop follows Flat HKey SegPool Log DB Tables XML XML To HKey Execute HKey to XML XML File CHIAPAS EDI 2012 USER MANUAL Page 33 lt L2000 gt lt 501 gt INSO1 gt lt 1 501 gt INSO2 INDVDL REL gt 18 lt 1 502 INDVDL REL CD INSO3 MAINTNC TYPE gt 030 lt 1 503 MAINTNC TYPE CD INSO05 BENFT STATS gt lt 1 505 BENFT STATS CD INSO8 EMPLYMNT STATS gt lt 1 508 EMPLYMNT STATS CD S01 S02 REF02 SUB ID OVL SUB gt 987654340 lt 02 SUB ID OVL SUB NR lt 502 gt lt 503 gt REF02 POLCY NR OVL POLCY NR 2BASICHEALTHCAREPLAN REF02 POLCY NR OVL POLCY NR lt 503 gt lt 504 gt REF02 SUPP ID OVL CLIENT REPRTNG gt 2100001 lt 0 2 SUPP ID OVL CLIENT REPRTNG
147. s additional columns Therefore the business elements sent via the Claim Adjudication Loop 2430 5010 837 Institutional will all be mapped as additional columns existing on every row because the HIPAA Implementation Guides defines that loop as having 15 iterations or less The columns associated with this deepest key loop will contain unique business information for every row within the transformed output and columns associated to loops higher in the hierarchy would inherit the information given in the previous row When converting this two dimensional structure back to an EDI message format each successive row is scanned for changes from the previous row and this would in turn trigger a new iteration of a loop In this way a two dimensional tabular data format is completely interchangeable with a hierarchical data format Because the two dimensional format is amenable to normal SQL all of the examples are oriented around interfacing with Chiapas EDI 2012 in this manner For an example see the following HIPAA EDI message and the equivalent CGIF flat table sees A POO ae e 5 ZZ SAMPL SENDRID ZZ SAMPL RECVRID 120906 1013 00501 100000000 0 P GS RA SENDR ID RECVR ID 20120906 1013 1 X 005010X218 ST 820 100000000 005010X218 BPR I O C CHK 1273801950 20120906 TRN 3 753476 N1 PE DOOLITTLE HOSPITAL FI 123400001 N APAS EDI TECH FI 273801950 E EI 987654324 STROGANOFF ABIGAIL N 00000005
148. s follows 1 SCHEDULED EVENT Arg 01 Current date and time 2 SQL TRIGGERED EVENT No information is propagated by the trigger 3 LOCAL UPLOAD DIRECTORY EVENT CHIAPAS EDI 2012 USER MANUAL Page 68 Arg 01 The full path and filename to the file Note that the trigger only fires after the file has been moved to its new location 4 LOCAL ARCHIVE DIRECTORY EVENT Arg 01 The full path and filename to the file 5 REMOTE UPLOAD DIRECTORY EVENT Arg 01 The full path to the local filename after it has been pulled to the local filesystem renamed and then moved to the new remote direction 6 REMOTE ARCHIVE DIRECTORY EVENT Arg 01 The full path to the local filename after it has been pulled to the local filesystem CGateMerge This activity allows a loaded to Flat register to be merged into an existing SQL Server database table Any fields that exist in the Flat register that are not present within the table will be flagged with an error message otherwise all fields that are in common to both will be inserted into the table This activity replaces all Lock associated commands and activities It requires an open database connection that is first set up with the CGateCNNAdd and CGateCNNOpen commands The loaded Flat register will then be converted into a series of SQL INSERT statements into the destination table If the source Flat register contains mappings not found within the destination table a log message will
149. sage to the Log including string data and two numeric data values Add Simple Error Adds a single error message Add Full Error Similar to the Add Full Message but logging the message as an error Clear Clears the message log CGateAckParse Activity CHIAPAS EDI 2012 USER MANUAL Page 58 This Activity translates the SegPoolAck register into a series of human readable error messages and writes them to the Log register This can be used in conjunction with the acknowledged file to determine the cause of any integrity issues that may be occurring CGateAckGenerate Activity This activity will load the SegPoolAck register with a basic 999 Acknowledgment transaction based on the results of a previously executed Decode operation If there was no critical error the 999 will show the transaction was accepted If there was a critical integrity error it will show that the transaction was rejected and which segment generated the integrity error The SegPoolAck register can then be saved to a 999 Transaction Acknowledgment file via the CGateTransfer Activity CGateSeg Activity This activity will set a number of options on the SegPool that will affect any file export operations These options will set the Segment Separator Element Separator Sub Element Separator and on the right Carriage Return at the end of a segment Line Feed at the end of a segment 80 columns split and whether to scrub Protected Healthcare Information
150. t as the SQL Server connection string to connect to the ChiapasData database that should have been installed as part of the Chiapas EDI 2012 installation These tables store information about triggers events logged messages and archive files CHIAPAS EDI 2012 USER MANUAL EVENTS Table Page 76 This table stores events Normally events are generated by the background ChiapasService when it scans an active trigger that meets its firing conditions When the CGateService background automation handler finds a triggering condition based off of the TSRC table it inserts a row into this table with an EVENT OWNER of 1 This will tell the WorkerProcesses maintained by the automation system that this is a new process and they will take ownership of the event and execute it Column Name EVENT ID EVENT OWNER TSRC ID EVENT DATAO1 EVENT DATAO2 EVENT DATA03 EVENT DATAO4 EVENT CREATED EVENT PROCESS BEGIN EVENT PROCESS COMPLETE EVENT RESULT Data Type INT PK INT INT VARCHAR 200 VARCHAR 200 VARCHAR 200 VARCHAR 200 DATETIME DATETIME DATETIME VARCHAR 200 Purpose Primary Key Identity This is refers to the numeric ID of the background worker process that took ownership and processed the event Foreign key to the Trigger table of the trigger that spawned this event Event Data 01 contents depend on trigger type Event Data 02 contents depend on trigger type Event Da
151. ta 03 contents depend on trigger type Event Data 04 contents depend on trigger type Timestamp of when the event was created Timestamp of when the event began processing Timestamp of the completion of processing Values CRITICAL ERROR SEE MESSAGE LOGS CRITICAL ERROR NO LOGS COMPLETE WITH MESSAGE LOGS COMPLETE NO LOGS CHIAPAS EDI 2012 USER MANUAL Page 77 FSTOR FILES Table This table stores filenames associated with an archive directory An archive directory is defined as a holding area that can receive new files either as a local directory or a remote SecureFTP directory an UPLOAD trigger This table stores events Normally events are generated by the background ChiapasService when it scans an active trigger that meets its firing conditions More information about events is in the Scheduling System section Column Name FILE ID TSRC ID FILE NM Data Type INT PK INT VARCHAR 250 Purpose Primary Key Identity Foreign key to the TSRC row associated with an archive trigger File name of the file Note that as the trigger is linked to a specific directory local or remote this does not contain path information CHIAPAS EDI 2012 USER MANUAL MSGLOG Tab Page 78 This table stores the Message Logs that are associated with a specific event They can be created either by the internal Chiapas EDI systems or added by the user via the MsgLog activity Column Name MSGLOG ID Origin
152. will insert a new Unmapped column You must manually Set it to a valid mapping before this can be used with the Chiapas Gate engine for encoding Col Removes the currently selected column Display This toggles the interface to display the entire mapping name in each column or to keep them fixed length and display only the first 15 character or so of each column gt Flat This button updates the Flat register from the interface so that the changes can be used with the rest of the system HIG If the HIPAA Implementatio Guides have been properly set up then this will launch Adobe Acrobat Reader and open the HIG to the correct page for the currently selected mapping within the Flat interface CHIAPAS EDI 2012 USER MANUAL Page 39 Mapping Interface This section covers the functionality of the group of pull down menus in the upper left corner of the Chiapas Studio screen These menus are tied to the active mapping selected within the within the Flat Tab EDI TECHNOLOGIES Inc healthcare enterprise salutians Specification 5010_834 5010 Benefit Enrollment and Maintenance Loop ISA Base Envelope X Iter Segment 01dSA Interchange Control Header g Hteration Element 02 Authorization Information Sub Element Overload 00 Authorization Information Present gt CGIFReference 501 15 02 AUTH NFO OVL NO AUTH The mapping interface has two function

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